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DENTAL INFECTIONS 

A "fc.TT"\ '-nun* 

AND THE 

DEGENERATIVE DISEASES 



ESTON -A- PRICE 



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(the iCibrary 

Dental ^rluuil 

IDcst lltnjhua llttmcrsitu 



A GIFT FROM 



H. Layman 
Fairmont, West Virginia 



. 



DO NOT CIRCULATE 







Digitized by the Internet Archive 

in 2012 with funding from 

LYRASIS Members and Sloan Foundation 



http://archive.org/details/dentalin02pric 



Volume II 

RESEARCHES ON CLINICAL EXPRESSIONS 
OF DENTAL INFECTIONS 



DENT/l 




A— Cross sec iton of normai km i joint of rabbit No. 1234 
Frontispd ce V( i.. II. 




B— CROS-^ SECTION I I \kiiikitk KNEE JOINT OF RABBIT No. 1234 

Frontispd a Vol. II. 




C— Spontaneous [nterstitial hemorrhage 



\KT MUSCLE OF KABBIT, WITH DEATH 



IN TWELVE lint RS FROM DENTA1 CU1 IURE. CASE NO. Y.U6. 

Frontispiece Vol, II. 



EXPLANATORY NOTES FOR FRONTISPIECES 
FOR VOLUME II. 

A AND B, NORMAL AND ARTHRITIC KNEES. 

In Volume I, I hare illustrated two quite different types of arthri- 
tis, one the proliferative type, characterized by marked prolifera- 
tion, deformity, and ankylosis, the other, the degenerative tybe, 
characterized by degeneration without fixation but with deformity. 
Both types tend to destroy the joint cartilages, the first by prolifera- 
tion changes, chiefly in the synovial membrane and perichondrium, 
and the second chiefly by degeneration of the body of the cartilage. 
In Frontispiece A, I have shown a section of a normal knee joint of 
a rabbit, in which will be seen the normal condition and arrangement 
of the various joint structures. In B will be seen the other knee of 
the same rabbit approximately two weeks after the development of 
an arthritic process resulting from injection into the ear vein of 
about two-thousandths of a gram of organisms, grown from a tooth. 
While this magnification is not high enough to show the minute tissue 
changes, it does demonstrate the gross structural changes. The plane 
is slightly different from that of the normal shown in A, as it in- 
cludes the posterior cruciate ligament. The joint capsule was rup- 
tured and the pus had extended into the fascia. The fixed film of 
congealed pus fell out of the section at the time of sectioning and was 
lost. There is marked destruction with necrosis of the joint capsule. 
The articulating cartilages have been practically destroyed, and it 
would be difficult, if not quite impossible, for this joint ever to return 
again completely to normal. This is a typical case of suppurative 
arthritis in the acute stage. ( For detailed discussion, see Chapter 64 
on Skeletal and Muscular System.) 

C. HEMORRHAGE INTO HEART MUSCLE. 

In Volume I, in the chapter on Changes in the Blood Stream, I 
have demonstrated the ease with which cultures from dental infec- 
tions may produce marked hematological and serological changes in 
the blood. These may involve marked change in clotting function 
of the blood, or produce changes in the walls of the blood vessels re- 



suiting in multipU hemorrhages either in special tissues or through- 
out the body. In Frontispiea C, I have shown in color a sal ion oj 

the heart muscle oj a rabbit which died in twelve hours front spon- 
taneous hemorrhages following inoculation with a culture front thi 
teeth of a patient suffering from both myocarditis and secondary 
hemorrhages. In the upper part of the illustration will be sun an 

artery in cross section normally filled with blood, the small spheres 
being blood cells, chiefly red. Xote the three laye rs of the arte ry wall, 
the intima, media, and adrenlilia. Just below it will be seen an 
arteriole, or capillary, the wall of which has only a single coat, the 
intima, corresponding with the inner coat of the artery. At the 
lower part of this it will be noted that this membrane is ruptured and 
the blood cells are percolating through the tissues and between the 
muscle fibers as an interstitial hemorrhage. The patient was 
changed from a distressed invalid to a comparatively normal matt 
by the removal of the dental infections. {For further details, see 
Chapter 60 on Circulatory System.' 



DENTAL INFECTIONS 

AND THE 

DEGENERATIVE DISEASES 



(Volume II) 



BEING A CONTRIBUTION TO THE PATHOLOGY OF FUNCTIONAL AND 
DEGENERATIVE ORGAN AND TISSUE LESIONS 



By 

WESTON A. PRICE, D. D. S., M. S., F. A. C. D. 

Specialist in Dental Research and the Diagnosis, Prognosis, and Treatment of Dental Infections. 

Chairman Research Section of The American Dental Association, 1914 to present. 

Organizer of The Research Commission of The American Dental 

Association. Organizer of The Research Institute of 

The American Dental Association 

(Discontinued) 

THIS IS THE CLINICAL ASPECT OF VOLUME I 

"Dental Infections, Oral and Systemic" 

Volume I Presents 

Researches on Fundamentals of Oral and Systemic 
Expressions of Dental Infections 

Volume II Presents 

Researches on Clinical Expressions 
of Dental Infections 



From the Author's Private Research Laboratories 
8926 Euclid Avenue, Cleveland. Ohio 



THE PENTON PUBLISHING COMPANY 

Scientific Publishers 

PENTON BUILDING CLEVELAND, OHIO 






Copyrighted 1923 

WESTON A. PRICE, D. D. S., M. S., F. A. C. D. 

CLEVEL Wl>. OHIO 
(Printed in thr United St»t< - of Vmei 



Printed by 

THE PESTOS PRESS CO. 

Clerclanil 



With Deepest Gratitude and Sense of Indebtedness 
for the Devoted and Loving Cooperation and Cheerful Sacrifices 

of 

My Wife and of Our Deceased Son, Donald, 

Who, at Sixteen. Paid with His Life 

the Price of Humanity's Delayed Knowledge 

Regarding These Heart and Rheumatic Involvements 

This Volume is Lovingly Dedicated 



Etiology 

N Full Fair Tide Let Information Flow — 
That Evil Is Half Cured Whose Cause We Know.' 



CI I l-RCII ILL: Gotham, 

Book 2, 65.'. 



TABLE OF CONTENTS -VOLUME II 



CHAPTER LVIII 

INTRODUCTION TO CLINICAL APPLICATIONS OF NEW 
INTERPRETATIONS 

CHAPTER LIX 

APPLICATION OF PRECEDING EXPERIMENTAL DATA IN- 
CLINICAL PRACTICE 



CHAPTER LX 



CIRCULATORY SYSTEM 
Endocarditis . 
Bacteremia . 
Raynaud's Disease 
Angina Pectoris 
Heart Block 
Hemophilia . 
Chronic Carditis 
Myocarditis . 
Carditis 
Phlebitis 
High blood pressure 



CHAPTER LXI 

RESPIRATORY SYSTEM 

Tuberculosis 

Dental Infections and Tuberculosis 

Streptococcal Pneumonia 

Head Colds .... 

Asthma ..... 



CHAPTER LXII 
PRIMARY AND SECONDARY SEX ORGANS . 

CHAPTER LXI 1 1 

KIDNEYS AND RELATED EXCRETORY ORGANS 

Kidney ........ 

Bladder 



CHAPTER LXIY 
SKELETAL AND MUSCULAR SYSTEM 
Deforming arthritis 
Osteomyelitis .... 

Myositis ..... 
Cyst and muscle spasm . 
Retained granuloma and rheumatism 
Osteomyelitis 
Spinal lesions 
Osteomalacia .... 



Pack 



19 



43 



54 

55 

62 

69 

71 

73 

73 

79 

83 

104 

108 

111 



113 
113 
118 
124 
131 
132 



135 



155 
155 
163 



172 
175 
200 
203 
217 
222 
227 
237 
240 



XI 



XII 



TABLE OF CONTENTS VOLUME II CONCLUDED 



CHAPTER LXV 

\LIMENTARY TRACT AND ASSOCIATED ORGANS 
Stomach 

Gall-bladder 
Gall-stones 

Intestines 

Stomach 

Intestines 

Appendix 

Stomach 

Cancer of the stomach 

CHAPTER LXV I 

NERVOUS SYSTEM AND SENSE ORGAN- 

Neuritis 

Central nervous system 

Rheumatic neuritis 

Mental cloud 

Sleepiness 

Sleeplessness 

Neuritis 

Nervous breakdown 

Chorea . 

Nervous exhaustion 

Loss of memory 

Epidemic lethargic encephalitis 

Eye 

Exophthalmos and retinal hemorrhagi 
Ears 

Obscure neuralgia 



CHAPTER LXV 1 1 



SKIN 



CHAPTER LXVIII 
ENDOCRINE SYSTEM 
Goiter 

Pancreas 

CHAPTER LXIX 
OTHER TISSUES 
Xerostomia 
Oral herpes 
Dental cysts 
Apicoectomy 
The repair of dentin and cementum 

CHAPTER LXX 
GENERAL DISCISSION 

CHAPTER LXX1 
GENERAL SUMMARY 

CHAPTER LXX11 
GENERAL CONCLUSIONS . 

CHAPTER LXX1I1 
RESEARCH INSTITUTES EOR DENTAL DISEASES 



Pace 
246 
246 

252 
257 
258 
259 
263 
264 
266 
267 



270 
273 
280 
283 
298 
299 
311 
312 
312 
315 
321 
323 
327 
335 
345 
347 



352 



357 
357 
362 



364 
364 
375 
377 
387 
391 



396 
399 

404 

it 6 



LIST OF ILLUSTRATIONS -VOLUME II 



Page 



262-B. Granuloma-like defensive membrane constructed about the 
root of an infected tooth, implanted beneath the skin of a rat. 
Note its high vascularity and intimate contact with the root, 
which is being absorbed by it. Rats have relatively high 
defense for streptococcal infections . . .22 

262-C. High powers of defensive reactions of the rat. A shows 
absorption of the cement um by cells with an osteoclastic 
and defensive function; B, these cells penetrating two foram- 
ina by chemotaxis ..... 23 

262-D. High power of one of the foramina of previous figure. Note 
the evidence of a common response to a general force- 
namely, chemotaxis by which these cells are attracted to 
the toxins and the bacteria producing them. They are also 
able to function as osteoclasts. Each cell is a Moating gland 
carrying antibody and antitoxin to neutralize the antigens 
and toxins produced by the bacteria. High defense in 
humans or animals, as demonstrated by this rat, is depend- 
ent upon the development and delivery of a large enough 
quantity of these defensive substances to carry the aggres- 
sive warfare to the immediate zone of the streptococcal 
invader, or as close as is physically possible, the limitation 
being the physical protection in the mechanical environment 
which is provided by an infected tooth structure, for the 
dentin of a single-rooted tooth contains approximately three 
miles of closed channels suitable for bacterial growth 24 

263 Roentgenographic appearance of teeth of Case No. 385 46 

264 Photographic appearance of extracted teeth of Case No. 385. 

(See Figure 263). 

265 Resistance and susceptibility history chart of Case No. 385. 

Note nine cases of heart disease in family, with four deaths . 49 

266 Acute endocarditis in two rabbits from 1 cc. culture from decid- 

uous teeth shown, from child with endocarditis . . 56 

267 Fatal endocarditis in a rabbit inoculated with about one- 

millionth of a gram of organisms from the washings of 
crushed teeth from a patient with endocarditis. Heart shown 
in A; the teeth in C and D; B, an aortic arch involvement 
from another rabbit inoculated from two other teeth from 
same patient, shown in E and F . . . .58 

268 Two rabbits with endocarditis from the culture of the ap- 

parently normal tooth in the insert. Patient was pros- 
trated by acute endocarditis ...... 60 

269 Streptococcal bacteremia : A, a degenerating granuloma of un- 

usually large size, from the second molar shown in B. E. F, 
and G show organisms grown from the blood taken from the 
median basilic vein on three different occasions. C, organ- 
isms in the blood aspirated from the neck; and C, organisms 
in_a phagocyting leucocyte ...... 63 

XIII 






\I\ 

LIST OF ILLUSTRATIONS Continued PMX 

270 Old Patrick. This rabbit lived for twenty-five and one-half 

months after one inoculation from culture* from t(X)th. Fig- 
ure 269. lit- developed first acute rheumatism, then de- 
forming arthritis, had bowed legs, and walked on the sides 
of hi- feet 64 

271 Other views of Old Patrick with his deforming arthritis. Not- 

withstanding his permanent deformity, he grew very la:. 
and heavy 

272 Multiple lesions produced in rabbits from a case of recurring 

streptococcal bacteremia. Case 987 66 

273 Others of the multiple lesions produced by the dental culturi 

from Case 987 with streptococcal bacteremia 67 

274 Source of culture for inoculations from Case 987 68 

275 Roentgenographs appearance of teeth, Case 1241 with angina 

pectoris. Patient apparently improved 70 

276 Effect of implanting a tooth from Case 1241 beneath the skin 

of a rabbit. B, photograph of the encapsulated tooth. C, a 
photograph of this rabbit's heart. I), section of the heart 
muscle showing fatty degeneration. A. a section of the kid- 
ney, parenchymatous nephritis 72 

277 Hemophilia. Case No. 1021. Roentgenographs appearand 

of the teeth. Note the absence of local reaction. Patient 
nearly dead from spontaneous hemorrhage, chiefly from 
gums, for three months, and most severe about root-filled 
teeth. See text ... 74 

278 Spontaneous hemorrhage in rabbit, causing death in twenty 

hours, from culture from tooth, upper right third molar. 

See Figure 277 . 75 

279 Spontaneous hemorrhages in rabbit's kidney and thigh. Cas< 

1024. Many rabbits developed delayed clotting of blood 
from this culture. Patient greatly improved 7(i 

280 Susceptibility history of patient and family. Case No. 1118 78 

281 Roentgenographic view of teeth of Caa No. 1118 with recur- 

ring heart involvement . 80 

282 Roentgenographic appearance of teeth of patient with myo- 

carditis. Case No. 13-16 80 

283 High angle view of upper right cuspid shown in Figure 282. 

Note difference in periapical appearand 85 

281 Section of heart wall of a rabbit which died in twelve hours 
from spontaneous hemorrhage from t(x>th culture of Case 
No. 1346. See also Frontispiece C 86 

287) Spontaneous hemorrhages in thigh of one rabbit and psoas 
muscles of another rabbit. Tooth culture from Case No. 
1346 

Smear from the urine of Case No. 1346, showing many pus 
cells which entirely disappeared after the removal of dental 
infections ..... 

287 Roentgenographic appearance of teeth of Case 1335 with 

history of severe heart involvement .... 90 



w 
LIST OF ILLUSTRATIONS Continued page 

288 Resistance and susceptibility record of family and patient of 

Case No. 133o. Note five deaths on father's side 91 

289 Roentgenographic appearance of teeth of Case 1009, a se- 

verely suffering invalid with degenerative arthritis. Note 
difference in local structural change . 94 

290 A very severe myocarditis produced in the heart of a rabbit 

inoculated with culture from Case 1414. A, low power; 

B, medium power of focalization .98 

291 High power of severe myocarditis produced in the heart of a 

rabbit inoculated with culture from Case 1414. Shows 
extensive necrosis, fibrosis, and vacuolization, which was 
not yet fatal when chloroformed .... 99 

292 Dental conditions of Case No. 1415 with high defense shown 

in Figure 294 101 

293 Dental conditions of Case No. 1414 with low defense shown 

in Figure 294 ... . 101 

294 Comparison of bactericidal properties of two bloods: Case 

1414, very low; Case 1415, very high. See difference in 
dental pathology in Figures 292 and 293 . .102 

295 Two severe heart lesions produced in rabbits inoculated with 

culture from Case No. 1067: A, myocarditis with hyper- 
trophy; B, endocarditis .... . . 105 

296 Roentgenographic appearance of dental conditions of Case 

No. 1057, suffering from severe acidosis, with heart, stom- 
ach, and rheumatic involvements ... 106 

297 Defensive reaction: A, encapsulated tooth chips; B, organisms 

in same; C, fibrous encapsulation tissue, very vascular . 109 

298 A severe case of phlebitis, produced in a rabbit's ear by in- 

oculation with a culture from a tooth of a patient who had 
recently suffered from a severe attack . .110 

299 A dental cyst which produced a high blood pressure reaching 

above 220, completely relieved by its removal . .111 

300 Dental infections which produced a condition diagnosed as 

pulmonary tuberculosis. After their removal the patient 
gained fifty-four pounds . . . . .115 

301 Roentgenographic appearance of teeth of Case 1153. Note 

absence of periapical absorption . .117 

302 Roentgenographic appearance of the dental infection pro- 

ducing a severe neuritis. Case 1120. Second molar has 
putrescent pulp . . . . . . .117 

303 Streptococcal pneumonia. Upper view — lungs of rabbit with 

influenza, not fatal to rabbits. Lower view — lungs of 
rabbit with influenza plus inoculation with small amount 
of dental culture, causing death from pneumonia 127 

304 A pneumonic lung with streptococcal pneumonia from the 

implanting of an infected tooth beneath the skin, shown 
also in position in this figure . . . .130 

305 Roentgenographic appearance of the teeth producing a sensi- 

tization reaction as acute recurring colds. Note extensive 
absorptions of both teeth and bone . 131 



XV] 

LIS! OF ILLUSTRATIONS Continued pace 

Roent aphic appearance of teeth, a culture from which 

produced the ovarian and tubal infection- in the next two 
figures 136 

307 Acute ovarian infections produced in rabbit- inoculated 

with culture- from teeth of patients suffering from same 137 

- other ovarian involvements in rabbit- from same culture. 

Case No. 10 138 

■ Several ovarian cysts produced from culture from teeth of a 
patient recently operated for ovarian cyst, shown in B, and 
cysts on the vas deferens from same culture 140 

310 A very large ovarian cyst produced in a rabbit from a dental 

culture Ml 

311 Roentgenographic appearance of teeth of Case 1224, the cul- 

ture from which produced the ovarian cyst shown in Figure 
31.!. The patient had recently been operated for removal of 
large ovarian cyst .142 

312 The sections of two rabbits showing ovarian cysts produced in 

from two to four days after inoculation with a culture from 

the teeth <>i Case No. 1224 . 143 

313 A very purulent uterine and tubal infection produced in a 

rabbit from the dental culture from a patient suffering from 
a purulent uterine discharge which entirely disappeared after 
the removal of her dental infection . 144 

31 1 A deep indurated ulcer on the inner surface of the fallopian 

tube of the rabbit shown in Figure 313 .145 

315 The highly inflamed fallopian tubes, ovaries, and uterus of a 

rabbit inoculated with a culture from the teeth of a patient 
with syphilis 146 

316 Acutely inflamed testicles, one from each of three rabbit - 

inoculated from the culture- of three different teeth of a 
patient suffering from acute swelling and pain in testicles. 
He had previously had gonorrheal or syphilitic infection 147 

317 The teeth from which the cultures wire taken producing 

results shown in Figure 316 . 1 \i> 

318 A helpless casting of multiple arthritis. She can scarcely move 

a joint in her body ..... 148 

319 Roentgenographic appearance of the teeth of the patient. Case 

No. 1269. This woman is a helpless bedridden cripple and 
severe sufferer, probably largely brought on by the overload 
oi -i\ pregnancies in seven years together with dental infec- 
tion- 151 

1 A helpless bedridden arthritic cripple, with bed -ore- a- large 
a- half an orange, lhr condition -tarted during pregnancy 

late in life when she had chronic dental infections . 153 

321 Susceptibility Study showing marked susceptibility to kidney 

involvement, including patient and four member- of father's 
family. Case No. 692 15b 

322 Rabbit reactions to tooth implantation- of case in previous 

figure. A and B, implanted teeth. C, cast in the rabbit's 
urine. 1 >. organisms in the rabbit's blood. E, casts in the 
patient's urine. F and G, nephritic kidney section- 157 



XVII 

LIST OF ILLUSTRATIONS Continued Page 

323 Tooth from patient with nephritis. See next figure 158 

324 Tooth of previous figure beneath the skin of a rabbit produced 

a slight local reaction but rabbit developed acute nephritis, 

as shown in next figure . ... 159 

325 Section of nephritic kidney with pus cells .... 163 

326 Acute interstitial nephritis produced in a rabbit. A and B, 

tissue sections showing cellular necrosis and edema. D, both 
kidneys of injected rabbit, five times normal size. See normal 
kidney to right, also hypertrophy of adrenals. C, casts from 
patient's urine. Case No. 573 . 162 

327 Two of the teeth of previous case producing kidney involve- 

ment. Note condensing osteitis, not rarefying . 163 

328 Susceptibility of previous case, No. 573. Note four cases of 

death from heart involvement on mother's side. . 164 

323 Teeth which produced acute and chronic cystitis, which 

promptly disappeared after their extraction . . 165 

330 Paralysis of the bladder with retention, produced in a rabbit 

by dental infection. Bladder is twenty times its normal 
<ize, as shown in B. A shows deep ulcer on inner surface of 
distended bladder . . . . . .166 

331 Susceptibility chart of apparently normal patient. Note eight 

cases of death from Bright's disease on mother's side. 
Examination of patient showed same acutely developed, 
though unsuspected, at age twenty-eight . . . 167 

332 Hypertrophied kidney and casts from urine of a rabbit which 

developed severe nephritis in sixteen days from the 
implanted tooth shown, well encapsulated . . .169 

333 Casts from urine of a rabbit dying in two days with kidney 

involvement, from the planting of an infected tooth beneath 

the skin ... ..... 171 

334 Typical illustration of streptococci and diplococci in joint fluids 

of animals inoculated with a dental culture . . .173 

335 Chronic deforming polyarthritis. This woman was a bedridden 

cripple, completely helpless for six years. She now walks 
about her house without even a cane and does beautiful 
fanevwork. Note condensing osteitis, not rarefving, about 
tooth. Case No. 709 . ... 174 

336 Some of teeth of previous case of deforming arthritis, extracted 

seven years ago . . . . . . . .176 

337 Histological studies of periapical bone. A, photograph of 

trephined cylinder. B, histological section. Note density. 

C, roentgenographic appearance. Case No. 709 . .177 

338 Acute purulent arthritis produced in rabbit from culture from 

tooth shown in C of previous figure. Case No. 709 . .178 

339 Arthritis of the spine and hips of patient shown in A, and in 

spines and hips of rabbits inoculated with cultures from his 
tooth. Case No. 1125 179 

340 Putrescent unfilled root of cuspid. Tooth had but slight apical 

absorption and no fistula ...... 180 



XVIII 

LIST OF ILLUSTRATIONS Continued Pagb 

341 Shows improvement in the movement of this man's spine in 

three months' time after extraction. A, limit of lateral 
movement at beginning. B, in three months. C, limit of 
forward and backward movement at beginning; and 1), after 
three months 1H1 

342 Susceptibility record of previous case, No. 1125. Note good 

inheritance; also in columns to right, duration of chief affec- 
tion was less than that of the dental infection. Spinal dis- 
turbance followed an injury pin-- his focal infection L82 

343 Extreme deforming arthritis produced in a rabbit inoculated 

with culture from the tooth shown in Figure 340, previous 
case. No. 1125 184 

344 Case ol deforming arthritis, bedridden for five years, progres- 

sively getting worse. So greatly relieved by removal of her 
dental infection and use of a vaccine that she now does her 
own housework and has for several years. Case No. 896 186 

3 15 Roentgenographs appearance of teeth of previous case. This 
patient had the degenerative type of arthritis, not prolifer- 
ative. Note difference in alveolar changes. An overgrown 
segment of mesial root of lower left first molar was uncovered 
by trephining. The bone changes are shown in the next 
figure . .... 187 

346 B, the overgrown root referred to in previous figure. A. section 

of bone showing original outline of trabecular C and I), 
concentric lamination obliterating a blood vessel 188 

347 Various views of a rabbit paralyzed by an inoculation from 

dental culture from previous case, No. 896 189 

348 Lesions of spine of rabbit shown in Figure 3!7. A and B, 

photographs showing diseased vertebrae'. C, degenerative 
necrosis of vertebrae adjoining the spinal cord. I) and E, 
roentgenographic appearance 190 

349 Degenerative arthritis of hand of patient. Case No. 896, with 

dislocation due to shortening of flexor and adductor muscles 193 

350 Acute deforming arthritis in boy seventeen years of age, bed- 

ridden much of the time for four years and crying by the hour 
with pain. Almost complete absence of alveolar absorption 
about putrescent teeth. Case No. 381 194 

351 Same boy and some of his handiwork, now greatly improved 

but deformed for life. Is he happy? 195 

352 Rabbit with acute rheumatism, inoculated with a culture from 

a putrescent lateral shown in B. Note the nearly complete 
absence of apical absorption 197 

353 Susceptibility of the preceding case. No. 381. Note dominance 

of rheumatism on both sides of family 198 

354 Roentgenographic view showing the free movement of mandi- 

ble which before dental extractions was ankylosed closed 199 

355 Extreme excementosis. Case 311 with carditis 201 

Overgrown bicuspid root of Case 311 201 

Osteomyelitis in a rabbit's hip, produced by the culture from 
the overgrown root tip shown in Figure 356 202 



XIX 

LIST OF ILLUSTRATIONS Continued page 

359 Roentgenographs appearance of a tooth with caries beneath a 

bridge which two years later produced torticollis on opposite 
side of neck of Case 455 ..... 207 

360 About two years later, patient attain suffered from torticollis 

and rheumatism. B shows putrescent lateral incisor appar- 
ently producing same; A, the patient's swollen wrist joints; 
D and E, rabbits with swollen feet and joints with acute 
rheumatism, inoculated with culture from putrescent lateral. 
C shows a lead bar in the tooth socket. Note the deceptive 
appearance of apical area of lateral in B . . 207 

3(51 Osteomyelitis produced in rabbits from culture from tooth in 
previous figure: A, normal; B, pathological; C, section 
normal; D, section pathological . 208 

362 Susceptibility study of Case 1081. Note absence of inherited 

susceptibility factors . . . . .210 

363 Roentgenographic appearance of teeth of Case 1081. Note 

zone of condensing osteitis surrounding rarefying, particu- 
larly of upper right second bicuspid, characteristic of a his- 
tory of a broken high defense. Patient suffering from acute 
pain and lameness in right shoulder . . .212 

364 Four views of a rabbit inoculated with culture from the teeth 

of Case No. 1081. When under anesthesia these neck mus- 
cles relaxed. At right, section of the cord and cervical nerves. 214 

365 Chronic degenerative myelitis of the spinal cord of rabbit of 

previous figure . .216 

366 Three sections of muscle tissue from neck of another rabbit 

suffering from torticollis . . 218 

367 An acute involvement of the muscles of the neck and shoulders 

shown in D, related to the cyst shown in C and B. Operation 
followed by rapid and marked improvement. A, a paralyzed 
rabbit inoculated from culture of same .219 

368 A section from the cyst wall of previous figure. Note osteo- 

clastic activity ... 220 

369 A photograph of the contents of the cyst shown in Figure 367. 

Large crystals are cholesterol . . . . 222 

370 A small dental cyst before and after operation, possibly 

originally a dental granuloma . 223 

371 Roentgenographic appearance of an osteomyelitis of the maxilla 

following an extraction. See Chapter 43. Volume One 228 

372 Normal articulating surfaces of rabbit's knee. Note excellent 

condition of cartilages, capsule, and joint structures . 232 

373 Pathological articulating surfaces of rabbit's knee with acute 

rheumatism. Slightly different plane from previous figure. 
Note necrosis of posterior cruciate ligament and cartilages 233 

374 Comparison of normal and arthritic knee joints of rabbits in 

nearly corresponding planes and different planes from the 
preceding figures: upper, pathological; lower, normal . 234 

375 Severe spinal lesions produced in rabbits by the injection of 

cultures from dental infections .... 237 



XX 

LIST OF ILLUSTRATIONS Continued pace 

376 Progressive development of a spinal disease resembling Pott's 

from inoculation of a dental culture . 239 

377 Three types of ossification: B. normal: A. proliferative ar- 

thritis; C, osteomalacia 241 

1578 Extreme tendency to periodontoclasia of patient suffering wiih 
osteomalacia. The systemic background makes this condi- 
tion easily progressive and, therefore, resistant to treatment. 243 

379 Two opposite types of reaction in cementum: A. hypocemen- 

tovis with destruction of cementum in osteomalacia and 
severe periodontoclasia; B, hypercementosis with extreme 
excementosis in patient with broken defense . 244 

380 Susceptibility study showing marked inherited susceptibility 

from mother'^ side for neuritis, nervous breakdown, and 
stomach trouble. Case No. 965 247 

381 Roentgenographs appearance of teeth of Case No. 965 with 

stomach and nervous disturbance . . 248 

383 Acute stomach ulcer with near perforation, of a rabbit inocu- 
lated with culture from a tooth of Case No. 965 with stomach 
involvement ........ 248 

Postings from three rabbits inoculated with a culture from the 
teeth of a patient suffering from spontaneous hemorrhages. 
A. shows a complete perforation of a rabbit's stomach; B. a 
Stomach just reach- to perforate; C, a near perforation of 
colon ....... 251 

385 Digestive tract involvements of rabbit of previous figure: A. 

non-vital molar; B, gall-bladder involvement; C, acute 
appendicitis; D, an inflammatory invagination of the cecum 
into the colon ...... 255 

386 Serious denial infections with little local evidence, which con- 

tributed to a very severe cholecystitis. Case No. 445 . 256 

387 Roentgenographs appearance of dental infections of a patient 

suffering from chronic cholecystitis. Following extractions, 
patient passed lifty-two gall-ston< . 258 

388 i vntal infections related to intestinal stasis and neuritis. Case 

No. 752 . . 259 

389 Susceptibility study of previous case, No. 752. Note five 

cases of acute stomach involvement on father's side, with 

two deaths .... 260 

390 An enormous mandibular cyst with marked displacement of 

third molar, nearly to neck of condyloid process, producing 
colitis. Case No. 1019 . 262 

391 Acute appendicitis produced in two rabbits in succession by 

planting <>f same tooth beneath the skin, taken from patient 
suffering from pain in vicinity of previous appendix opera- 
tion ... 265 

Internal and external appearances of acutely involved appen- 
dix ol a rabbit with tooth implanted beneath its ^km. from 
Case No. 1346 suffering from a digestive disturbance' . 266 

393 Stomach ulcer produced in rabbit by tooth implantation. Case 

No. 1346 with stomach involvement .... 267 



XXI 

LIST OF ILLUSTRATIONS Continued PaG e 

394 A remarkable instance of inherited susceptibility for stomach 

involvement. Note six of patient's immediate relatives 
suffered from same, with three deaths .... 268 

395 A dental infection which produced a tipping of the head, com- 

pletelv relieved by the extraction of the bicuspid. Case 

No. 110 . 270 

396 Four rabbits were inoculated with the culture from the tooth 

shown in D, three of which were completely paralyzed from 
the centers of their spines backward, as shown in A, B, and 
C. Patient suffered from spasms. Case No. 1001 . . 271 

397 Paralyzed rabbit, A and B. C, an ulcer on inner surface of its 

bladder, shown in next figure ...... 272 

398 Site of lesion in spinal nerves in D. E, the paralyzed bladder 

twenty times normal size . . ... 274 

399 Photographic appearance of ventral surface of spine, with one 

destroyed cartilage ..... . 275 

400 Another paralyzed rabbit of this series. A, roentgenographic 

appearance of spine. Note condensing osteitis. B, compres- 
sion of spinal cord by proliferative osteitis. C, external 
appearance of rabbit ...... 276 

401 Lesions in the cortex of the brain, rabbit which developed 

acute choreic nervous symptoms, shown in Figure 347 . 278 

402 Roentgenographic appearance of the teeth of Case No. 484; 

patient suffering with rheumatic neuritis and heart, with 
extreme muscle atrophy . .281 

403 Susceptibility record, Case No. 484. Note the strongly 

inherited susceptibility for heart and rheumatism, with four 
deaths from stroke ....... 284 

404 Susceptibility record of Case 1178. Note strongly inherited 

susceptibility for stomach involvement and neuritis . . 286 

405 Roentgenographic appearance of teeth of Case 1178. Note 

limited periapical absorption about lower first molars. 
Patient suffered from extreme nervousness . . . 288 

406 This Rabbit 716 carried or dragged its hind leg from a culture 

from the tooth shown on opposite page. See next figure 289 

407 A series of roentgenographic views of progressive develop- 

ment of hip disease in Rabbit 716, shown in previous figure. 
Culture from tooth in Case 1178 . . 290 

408 Photographic appearance of heads of femurs on posting, 

Rabbit 716 . . . .291 

409 Enlarged views of normal and diseased femurs of Rabbit 716 

from Case No. 1178 ... .291 

410 A smear showing diplococci in pus from hip joint of Rabbit 716 292 

411 Rabbit 710, which developed paralysis of hind legs from dental 

culture from Case 1178 . . . 292 

412 Roentgenographic appearance of lesion in the spine of para- 

lyzed rabbit, 710. Case 1178. A, lateral view while living. 
Note condensing osteitis. D, C, and B, ventral and lateral 
views. Note condensing osteitis ..... 293 



XXII 

LIST OF ILLl STRATIONS Continued 

113 Smear from kidney of rabbit with nephritis from denial infec- 
tion, showing pus cells and streptococci 291 

ill Centra] nervous system changes in Rabbit 632 with chorea. 
nystagmus, torticollis and gyratory movement-: A, a focal- 
ization in cerebellum of brain; B, fatty defeneration in ijray 
matter ol cord 295 

11.) Lesions in tin- aortic arch of Rabbit 122 297 

116 Typical degenerative arthritis of joint capsule of Rabbit 624 298 

117 Roentgenographic appearance of teeth of Case 1273 with 

extreme sleepiness . 300 

118 Dental condition- of Case No. 557, with violent spells of 

insanity coming on as sleeplessness 300 

119 Susceptibility record of Case No. 557. with insanity and 

marked inherited susceptibility to nervous breakdown, and 
mental cloud 302 

120 Dental condition- of Case No. 102, with nervous disturbance 

as crying ... 304 

121 Roentgenographic appearance of teeth of Case 1139 . 304 

122 Dental condition of Case No. 1082. Mild insanity greatly 

improved by removal of dental pathological condition 307 

123 Susceptibility record of Case 787). with sciatic rheumatism and 

heart. Note marked hereditary susceptibility, with five 

death- from heart involvement on father - - side and one case 

on mother'- side . 308 

12 i 1 )ental condition- ol Case No. 1139, suffering with acute neuri- 
tis, completely relieved by removal of dental infection- . 310 

125 I >ental condition of Case No. 805. booked for an insane asylum 

as a bedridden invalid with palsy. Remarkable relief from 
removal of her dental infections 310 

126 Infected deciduous molars, without roentgenographic evidence 

of same, which were producing chorea in a child. O 

No. 1 102 315 

127 Roentgenographic appearance of teeth of Case No. 335. with 

hysteria and lassitude. See next figure 316 

128 Susceptibility record ol Case No. 335. Suffered acute lassitude, 

hysteria, heart, and rheumatism. Note ten cases of heart 
involvement in family 318 

129 Dental condition of Ca-e No. 1365, suffering with attack- of 

extreme loss of memory. These were ocxnirring with increas- 
ing severity and frequency. Very marked relief upon re- 
moval <>f denial infection- 320 

130 Dental conditions ol Ca-e No. 1517. Patient suffering from 

lethargic encephalitis 321 

131 Denial condition- ol Ca-e No. 904, with acute inflammation 

oi the sclera and retina of the right eye 326 

Dental condition- of Ca-e No. 1087, with complete blindness 
in right eye, left eye one-fifth normal 326 

; ressive involvement in rabbit'- eye, from dental culture 
from Ca-e 904 with retinitis 328 



Will 

LIST OF ILLUSTRATIONS Continued Page 

434 Of five rabbits inoculated with culture from teeth of Case 904, 

four developed acute eye involvement. Two shown below 
have ulcers, and two above acute infection of musculature. 329 

435 Very extreme excementosis of a molar root. Case No. 1087, 

with a history of glaucoma resulting in complete blindness of 
one eye and one-fifth vision in the other. Vision progres- 
sively diminishing. Marked improvement following removal 
of dental infection 330 

436 Acute conjunctivitis in rabbit, produced by culture from 

infected tooth in D, from Case No. 899 with chronic eye 
irritation and hip involvement .... 332 

437 Extreme eye involvement of Case No. 861. B, C, and D, 

dental conditions. E and F, progressive stages of acute 
involvement in rabbit's eye, inoculated with culture from 
these teeth ... ... .334 

438 Marked bulging of the eyes, Case No. 1008, as seen in A. Eyes 

returned to normal in a few weeks' time, as shown in B 336 

439 Roentgenographic appearance of teeth of previous case, No. 

1008 .... .337 

440 Very marked pulp degeneration, with multiple pulp stones of 

pyorrhetic teeth of previous figure. Case No. 1008 . 338 

441 Three rabbits which developed acute exophthalmos following 

inoculations with dental cultures from preceding case, 
No. 1008 . 339 

442 A ruptured blood vessel in patient's eye, shown in A, with 

hemorrhage into sclera. B, a hemorrhage into the eyeball 
of a rabbit from culture of tooth. C, hemorrhage into 
periosteum and muscles ...... 340 

443 An acute involvement of both eyes of patient shown in C. A, 

normal eye of rabbit. B, same eye the day following the 
inoculation with culture from teeth shown in D. Case 
No. 987 . 342 

444 Dental condition of Case No. 1111, with attacks of temporary 

complete blindness. No return of attacks at last report, two 
years after removal of dental infections 346 

445 Dental condition of patient with acute pain in both ears, chiefly 

left. Relieved by removal of dental infections . 346 

446 Obscure neuralgia of dental origin: E, crowned vital tooth; 

D, without crown; A, degenerating pulp with calcifications; 

B, cross section of degenerating pulp with calcifications; 

C. high power showing hyperemia and dilation of vessels 
with calcification . . . . 348 

447 Radiographic appearance of dental lesions related to an acute 

herpes zoster, which promptly disappeared after their 
removal. Case No. 841 ... 353 

448 Upper lateral which, when removed, completely relieved a 

distressing itching of the skin. Case No. 1114 354 

449 Dental condition related to a case of hyperthyroidism in a 

young woman, aged twenty. Conditions returned rapidly to 
normal following their removal. Case 628 358 






LIST OF ILLUSTRATIONS Continued page 

150 Roentgenographs appearance of dental conditions of very 

severe case of exophthalmic goiter with heart involvement. 
Patient very rapidly recovered after removal of the dental 
infections. Case 171 359 

151 Susceptibility record of Case No. 171, with heart and goiter 

involvement and nervou< breakdown. Note marked heredi- 
tary susceptibility for nervous system and heart, with six 
deaths from the latter 360 

152 An enormously hypertrophied thymus which developed in a 

rabbit inoculated with a dental culture . 362 

453 Upper, normal sublingual gland showing lobe and duct and 
numerous normally functioning lobules or acini; lower, 
pathological sublingual gland of Case No. 955, showing 
degenerated lobe. The lobules, or acini, are nearly all 
destroyed, a few intact but breaking down 3(50 

455 Typical degenerative necrosis of sublingual glands of different 

cases of xerostomia . ... 369 

456 Xerostomia. Case No. 955. A, roentgenographic appearance 

of left mandibular second molar; B, photographic appear- 
ance of bifurcated mesial root; C, hypertrophied lobules of 
patient's sublingual gland ... 370 

157 Sublingual, submaxillary, and parotid glands: In A, from a 

normal rabbit; in B, from a rabbit inoculated with a culture 
from a tooth shown in 456 ... . . 372 

158 B, a pair of greatly hypertrophied sublingual glands produced 

in a rabbit from cultures from Case No. 955 with xerostomia 
and rheumatism. A, an acute suppurative arthritis in same 
rabbit ......... 373 

159 Section of sublingual gland from Case No. 1136, suffering from 

xerostomia. Note marked degeneration of acinus and 
secreting lobule 374 

160 A suppurative and hypertrophied sublingual gland of a rabh.it 

inoculated from Case No. 1136 375 

161 Section of sublingual gland of Case No. 1185. suffering from 

xerostomia. Shows a degenerative lobule with fibrosis 37(5 

462 Oral herpes. An acute streptococcal abscess beneath the 

epithelial layer of the mucous membrane 577 

163 A dental cyst which produced a very acute heart involvement 
in a boy of fifteen. Pulse rate dropped from 160 to 80 in a 
few hours after evacuation of cyst, with rapid and complete 
recovery ... . . 378 

464 \ dental cyst which -tailed with the left mandihul. r bicuspids 
and extended to the right cuspid, shown in A and B. C 
show- the absorbed root apices of the lower in« w rs and left 
cuspid. Patient, suffering from heart block and symptoms 
of stroke, had a remarkable recovery 380 

165 \ huge cyst bulging the check and eye. B. roentgenogram of 

enormous cyst chamber filled with opaque The maxillary 
sinus had been entirely obliterated 381 

166 Oral appearance of cyst shown in A. B, entrance made to the 

cyst in the oral cavity. Case No. 1098 382 



XXV 

LIST OF ILLUSTRATIONS Concluded Page 

467 A, a roentgenographs: view; B, artificial denture and splint 

to support the destroyed cheek hone and permit oral mucous 
membrane to extend and displace all cyst tissues. Results 
excellent. C, section of bone adjoining advancing cyst. 
Note the active osteoclastic process. Case No. 1098 38 1 

468 Heart of a rabbit with endocarditis produced by the inocula- 

tion of culture from Case No. 1098 . . 386 

469 Reactions on a resected tooth: A, low power view of stump; 

B, absorptive membrane, medium power; C, osteoclastic 
activity absorbing tooth ....... 388 

470 An apparent repair of dentin of an overgrown third molar root 

left by a previous extraction: A, roentgenographic appear- 
ance of root in mandible; B, roentgenographic appearance 
of imbedded root; C, section through mesial and buccal 
roots . . . 392 

471 Higher power of areas of Figure 470. A shows filling in of the 

pulp chamber with an osteoid bone through which a blood 
vessel was passing; B, an osteoid bone built upon the frac- 
tured surface of dentin, over which is a layer of cementum; 

C, a high power of the osteoid bone of A ; and D, a high power 

of the osteoid bone of B ...... 394 



LIST OF FOUR-COLOR ILLUSTRATIONS VOL. II 

Frontispiece a. ] ' v - 1 

Cross section Of normal knee joint of rabbit No. 1234. 

Frontispiece B. 
Cross section of arthritic knee joint of rabbit No. 1234. 

Frontispiece C. 
Spontaneous interstitial hemorrhage into heart muscle of rabbit, 
with death in twelve hour- from dental culture. Case No. 1346. 

Figure 

358 A cross section of muscle fiber- which was dissected from the 
trapezius muscle of the neck of a patient with acute torti- 
collis, which shows the- streptococci and diplococci within 
the sheath of tin- muscle fiber. Case No. 455 20o 

384 Multiple abscesses in the wall of the gall-bladder of a rabbit. 
produced by inoculation with the culture from a tooth of a 
patient scheduled for gall-bladder operation. Symptoms 
entirely disappeared after removal of dental infection. No 
return of symptoms in two and one-half years. Case No. 
1048 . .253 

454 Xerostoma (Dry mouth) section of sublingual gland of patient. 
Case No. 955, showing a chronic proliferative interstitial 
inflammation, with necrotic destruction of acini. The infec- 
tion is with diplo- and streptococci . . . 36/ 



\x\ I 



PREFACE 

SINCE this Volume is an analysis of the clinical expressions of 

systemic dental infections, it is primarily a discussion of their 
broader symptomatology. I have not, therefore, deemed it needful 
that I discuss these problems here from the standpoint of furnishing 
more data in substantiation of the systemic expressions and effects 
produced by dental infections, since Volume I furnished abundant 
data to that end. The data, which these researches have developed, 
are so ample and convincing to me that I see no escape from the 
conclusion that many of the degenerative diseases— as nephritis, 
myocarditis, endocarditis, arthritis, neuritis, gastric ulcer, chole- 
cystitis, appendicitis, neurasthenia, psychoneurosis, iritis, retinitis, 
myositis, pancreatitis, etc., etc., hare as one of their important, 
and in many cases their chief causative factor, dental infections. 

The researches recorded in Volume I, on the oral and systemic 
expressions, make clear why nearly all have been misled by the 
mistaken premise that absorption of bone is an effect of infection 
and its extent its measure, confusing activity of the host as being 
activity of the invader. We mistook reaction for invasion. Poten- 
tially, various infected teeth are more nearly comparable than we 
have thought, the difference being in the reactive defense of the host; 
and when an adequate defensive reaction does not occur close to the 
source of infection, it only means that that combat must take place 
somewhere else. Every individual with an infected tooth, therefore, 
must have either an efficient quarantine station immediately about 
that tooth, as a granuloma, or have, as the result of that warfare 
taking place elsewhere, some systemic effect, which effect will appear 
in the weakest tissue, not the strongest. The weak tissue will be 
determined, as I have shown in Volume I, by inheritance in part 
and by overloaded or injured tissue in part. It is probably seldom, 
if ever, the case that the denial infection is the only contributing 
factor. 

I have not repeated over and over, out of fear of being misunder- 
stood, that I do not believe dental infections to be the only sources of 
these systemic troubles because of my confidence in the good sense of 
the readers. This is not a work on the systemic expressions of focal 

15 



L6 PREFACE 

infections oj other types, as. foi example, the genito-urinary tract. 
It is, however, applicable to all forms of focal infections of strepto- 
coccal origin, especially when existing in bone, for tin sami lau 

susceptibility, defense, overloads, etc. will obtain; and a strepto- 
coccal 01 staphylococcal) infection nil! finally contaminaU and 
assist thai infection which will finally take the lives of nim out of 

U u of us as ic( go out with souu on< or nunc of the (legem rutin 
diseases. Winn will tin streptococcal culture come from? In 
many cases from infected lath and tin secondary lesions planted 
by them throughout the body. In nim out of ten of us that final 
combat may come as a premature so-ca'led e>ld age or degenerative 
disease, and many years before it should, not only because of need- 
less dental infections, but also because of Other overloads, one of the 
most important of which is faulty nutrition and diet. I have shown, 
for example , that a normal rat will exfoliate an infected tooth, when 
planted beneath the skin, in an averagi of six days, while it will take 
over forty days Jar rats on a deficit ncy diet to do so. As I see it tunc, 
the diet deficient in mineral bases produces many organ and tissue 
lesions, such as those of the kidney and blexxl vessels, which weakened 
structures readily become infected if a source, such as an injected 
tooth, exist, and together they produce a grave nephritis. Time 
after time, however, we have seen the albumin disappear from the 
urine after the removal of the dental infection without changing the 
diet. It is better, of course, to do both. Similarly, this volume will 
detail many cases of heart involvements relieved so completely as to 
justify a new prognosis for many of these heretofore grave cases. 

The importance, if ne>t gravi m c< ssily. for these intensive researche s 
is suggested by the following facts: 

{1) In the statistical are as of the L 'nite d Stale s. as also of England 
and Wales, the percentage of deaths of all ages attributed to pre- 
mature failure of the heart function exceeds 10 pi r cent. 

L' The pe reenter^ incre ase S re ry rapidly above forty ye ens of age, 
and at sixty-Jive being above 20 per cent. 

(3) It is estimated that subacute endocarditis is caused in 95 per 
cent of cases by Streptococcus Viridans. Libmau: J. A.M. A.. 
\ '<>l. so. No. 12: Characterization of various forms of e ndocarditis.) 
1 In the culturing of several thousand teeth with pulp involve- 
ments more than 99 per cent have been found to be infected with 
diplococci or streptococci {mostly green-producing or viridans). 

5 Statistics of the United States Public Health and Census 
Departments indicate that whih the death rale from infectious 



I'KKI \CK 17 

diseases is decreasing, it is increasing for heart involvements, 

kidney involvements, and other degenerative diseases. 

{6) The great majority of adult individuals are carrying seriously 
infected teeth, potentially capable of producing degenerative diseases 
if the local and systemic quarantine breaks down. 

(7) The great majority of adults and children are, therefore, 
carrying as dental foci, the strains of organisms which are found 
in a great majority of heart, kidney, joint and muscle, and nerve 
lesions, and which are potentially capable of producing these in the 
absence of an adequate defense. 

If mankind be flow passing through the third great transition for- 
ward — the first being the development of the thumb, perfecting the 
hand; the second, the development of the stone implements, and this, 
the third, his mastery over his parasitic enemies — an opportunity 
has come to the members of the medical and dental professions, 
infinitely greater than to any other of the sciences of mankind, to 
contribute to mans upward march to the position of a superman. 
Could any compensation compare with this aristocracy, the members 
of which have been selected for the unique service of lengthening days 
and wiping away the tears from many eyes? How the words of 
Christ "Ye shall know the truth and the truth shall make you free' 
are being fulfilled over and over these days by the ridding of the world 
of the great devastating infective plagues! May it not be that like- 
wise the chief remaining plague — the degenerative diseases — shall 
likewise be reduced and ultimately banished from civilized society 
as it is from the simply living animal world and some of the simply 
living human tribes? 

In the Journal of the American Medical Association {Septem- 
ber 15, 1923) there is a report from the London correspondent, 
under the subtitle "The Dental Condition of the Population," calling 
attention to a report from a government committee as follows: "It 
was now known, on the authority of a government committee's report 
that one-third of all the diseases in the country was due, directly or 
indirectly, to dental disease." If that be true, and I believe it is in\ 
many communities, that third of human misery can be, and will be 
largely banished: first, by proper nutrition and mastication; second, 
by proper prophylaxis; and third, by proper dental surgery, the 
latter being unnecessary in proportion as the other two are efficient. 

This volume contains a review of cases which are typically illus- 
trative of their classes. They have been selected from many thousand, 
most of whom have been benefited, and many very greatly. The 



\H PREF \i I. 

chiej messages, therefore, oj this volunu an first to demonstraii tin 
types of degenerative disease that may bi benefited by removal of 
dental infections; second, to demonstraii tin types of cases that may 
In prevented and, therefore, nevei requin to bi corrected, and third, 
to demonstrate tin conditions, which, when established, may nan 
bi relieved and may const it nti a living death mor< horribk than any 
inquisitor's rack, and, at present, preventdbli only by an ad((/nati 
preventative program. 

I am profoundly indebted to thesi patients for their complett and 
helpful cooperation, without which thesi researches could not havt 
been carried toward and recorded; and tin testimony of tin ir extended 
years of life and comfort constitutes tin only answt r that is needed to 
the question of the relation of dental infection to tin degenerativi 
diseases. 

Weston A. Price 
September, 1923 
8926 Euclid Ann in 
Cleveland, Ohio 



CHAPTER IA III. 

INTRODUCTION TO CLINICAL APPLICATIONS ( )F NEW 
INTERPRETATIONS. 

DISCISSION. 

In the following chapters we will review the results of applying 
these principles in approximately two thousand cases with sys- 
temic involvements, and from these we will select typical illustra- 
tions of various types of lesions and outline, in more or less com- 
plete detail, our methods of study and the clinical results, and in 
a large number of cases will present the results of animal experi- 
mentation with the cultures taken from the case in question. 
The basis on which the cases have been selected, to illustrate the 
applications, has been quite largely the degree of completeness of 
the data. For example, in cases where we could not secure quite 
complete family histories, we have excluded these charts from the 
records included on susceptibility, or where individuals have gone 
out of our direct observation. We have endeavored to show- 
exceptions to rules in order that we might explain our interpreta- 
tions for them; and, particularly, we have tried to select typical 
failures as being quite as helpful as successes. 

Our basis of classification has been that suggested by Raymond 
Pearl," and is based upon the biological classification of tissues. 
It has the advantage, that lesions in associated tissues may 
be considered consecutively and in more intimate relation- 
ship, than would be possible with the ordinary anatomical classifi- 
cations. 

It should be noted that the patients coming to a diagnostic 
clinic would tend to be quite dissimilar from those presenting in 
an ordinary dental practice. It, therefore, will not be possible for 
general practitioners and specialists to make direct comparisons 
of general data, though they may of special, for there is constant 
danger that the specialist seeing, as the majority of his patients, 
those in the breaking class, will tend to read into pathology of 
lesions a much greater danger, than the general practitioner who 
is dealing largely with well people rather than ill, and who sees 

*From Proceedings of National Academy of Sciences. Dec. 1919, Vol 5 5 No. 12 

19 



20 DENTALINFEC riONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

such large proportions of his clientele without apparent injury. 
This latter operator must keep in mind that whereas the former, 
the diagnostic specialist, is quizzing every patient in detail and 
then-lore disclosing many affections which the patient was not 
associating, although important and definitely established, the 
general practitioner will usually have no knowledge of such con- 
ditions if they exist, both because he is used to seeing so large a 
proportion of his patients free from such lesions and because he 
makes no special and adequate effort to disclose the conditions, 
even when present. 

We will, accordingly, take up the study of these problems in 
the order implied by the following classification of tissues on the 
basis of their biological characteristics: 

1. Circulatory system. 

2. Respiratory system. 

3. Primary and secondary sex organs. 

4. Kidneys and related excretory organs. 

5. Skeletal and muscular system. 

6. Alimentary tract and associated organs. 

7. Nervous system and sense organs. 

8. Skin. 

9. Endocrine system. 
10. All other tissues. 

As I proceed in the following chapters to make an application 
of the data developed in the preceding researches, I shall be com- 
pelled to leave out of this report detailed statements involving 
methods of procedure. Laboratory methods are of great impor- 
tance and. of course, fundamental for the individuals making the 
part icular determinations. It is not feasible, however, to combine 
in a single bock a manual of laboratory technic with a discussion 
of clinical and structural pathology. I am. accordingly, accumu- 
lating for a separate publication, various data that will be most 
helpful in diagnosis, prognosis, treatment, and prevention. This 
text will be too voluminous without that extensive discussion 
All biological chemists will be familiar with the literature and 
methods tor the various chemical procedures involved in the 
determinations herewith presented. As a further assistance to 
them I am presenting as an appendix to this, a bibliography of 
the reference literature involved. 



CHAP. l.\ ill l\ PRODUCTION 2\ 

In Volume I, I have presented a quantity of new data which has 
indicated the necessity for important new interpretations of 
fundamentals, one of the most urgent of which is a complete 
change in conception and understanding of the meaning and sig- 
nificance of the various types of reaction about infected teeth. 
Much of the present diagnosis is based upon a misconception of 
the nature of the defensive reactions about an infected tooth. I 
have shown that that individual or animal is most safe that can 
carry on the most vigorous reaction immediately about the in- 
fected tooth and that the structural changes that take place are 
primarily an indication of the activity of the host rather than of 
the invading organism. To impress further this point I am show- 
ing here four views of the reaction produced by a rat, which ani- 
mal has a higher defense for streptococcal infections than either 
humans or rabbits. 

In Figure 262-B will be seen a granulomatous type of tissue 
which is the defensive structure produced by this animal. This 
surrounds completely the apex of the infected tooth. This 
rat with its high defense is able to carry his warfare up to and 
into intimate contact with the tooth's surface. The no-man's- 
land between these two engaging forces is somewhere in the tooth 
structure, whereas in most humans on some parts of the tooth it 
is some distance away from the tooth structure. Only those in- 
dividuals are able to absorb an infected tooth who can carry their 
attacking forces completely up to the tooth surface and as the 
host's defense goes down this point of contact moves back away 
from the tooth until in broken defense it is distributed all through 
the body. In A of Figure 262-C, it will be noted that this war- 
fare of the host is actually busy tearing down the infected tooth 
to dismantle it. These cells have as their primary function the 
defending of the host. In B two foramina are shown, which 
penetrate the cementum, and it will be noted that these de- 
fensive cells have penetrated deeply into these minute chambers 
in search of the enemy by a process of chemotaxis. In Figure 
262-D will be seen a higher magnification of this process, which 
shows in a most graphic and striking way their effort seemingly 
to crowd each other away in order that they may be able to 
get at the enemy. 

In Volume I, I have shown these cells passing into glass 
tubes in search of the enemy by this same fundamental law of 
chemical attraction of these defensive cells toward attacking in- 



L r ! DENTAL I XI it I IONS5 DEGENERATIVE DISEASES CLINICAL VOL. II 






-*.-'•' 








)' 






>*. 






> '• 






I i. .11.1 262-B GRANULOMA-LIKE DEFENSIVE MEMBH \M < 0NSTR1 i 11 M VBOl 1 nil Rl OTOE W INFECTED TOOTH, 
IMPI VNTED BENEATH THE SKIN 01 \ R \ l NOTl ITS HIGH VASCULARITl VND INTIMATE CONTACT WITH Till-: ROOT, WHICH 
I- Bl IN( \BSORBED B\ IT. RATS HAVE KM I \11\11 V HIGH Dl 1 1 NSE FOR STREPTOCOa \l INI ECTIONS 




■*^i^_ 










•- S& - 










!S 



Figure 262-C High powers of defensive reactions of the rat. A shows absorption of the cementum by 

CELLS WITH AN OSTEOCLASTIC AND DEFENSIVE FUNCTION; B. THESE CELLS PENETRATING TWO FORAMINA BY CHEMOTAXIS. 

23 



24 DENTALINFEX PIONS & DEGENERATIVE DISEASES CLINICA1 VOL.11 







Figure 2ti:M). High power of one of the foramina of previous figure. Note the evidence of a common 

RESPONSE in A GENERAL FORCE NAME! V. CHEMOTAXIS BY WHICH THESE CEL] 5 ARK ATTRACTED TO THE TOXINS AND THE 
BA< II RIA PRODUCING THEM. THEY ARK ALSO ABLE TO FUNCTION AS OSTEOCLASTS. EACH CELL IS A FLOATING GLAND 
CARRYING ANTIBODY AND ANTITOXIN To NEUTRALIZE THE ANTIGENS AND TOXIN'S PRODUCED BY THE BACTERIA. Hl(.ll 
DEFENSE IN HUMANS OR ANIMALS. A^ DEMONSTRATED BY Tills RAT. IS DEPENDENT IRON THE DEVELOPMENT AND DELIVERY 
OF A I ARGE ENOUGH QUANTITY OK THESE DEFENSIVE SUBSTANCES To CARRY THE AGGRESSIVE WARFARE To THE IMMEDIATE 
ZONE OK THE STREPTOCOCC \I INVADER, OR AS CLOSE As Is PHYSICALLY I'osslBLE. THE LIMITATION BEING THE PHYSICAI 
PROTECTION IN THE MECHANICAL ENVIRONMENT WHICH IS PROVIDED BY AN INFECTED T(X)TII STRUCTURE, FOR THE DENTIN 
< 'I VSING1 E-ROOTED TOOTH CONTAINS APPROXIMATELY THREE MILES OF CLOSED CHANNELS SUITABLE FOR BACTERIAI (.ROWTH. 



Uctions, provided that (and herein lie the tragedies that consti- 
tute this volume) the individual does not have these defensive 
forces, either lacking by inheritance or by overload, or over- 
whelmed by the presence of the infection through the instru- 
mentality of its toxins. If we will keep this important interpre- 
tation in mind as we study the successive illustrations of the 
clinical expressions, which accompany and are the result of a 
broken defense, it will, in a most important way. help to clarify 
the involved problems. 



CHAP. LYIII INTRODUCTION OLD AND NEW FUNDAMENTALS 



25 



Since the clinical data and procedures recorded in this volume 
are the result of the application of the data developed in Volume 
I. I am repeating herewith for ready reference and guidance the 
New Interpretations along with the Old, from which they were 
developed but have not given here the data on which the new are 
based. These will be found in the various research chapters, 1 
to 44, in Volume I, and in the twelve chapters on interpretation, 
45 to 56 inclusive. Problems 1 to 17 are current or old funda- 
mentals for diagnosis, prognosis, and treatment, for which I have 
given new interpretations. In Chapters 18 to 44 I have presented 
new problems which I consider to be additional fundamentals. 



OLD INTERPRETATIONS 



NEW INTERPRETATIONS 



NO. 1. ROENTGEN-RAY LIMITATIONS 



{a) Roentgenograms of teeth 
will reveal the presence of infec- 
tion. 

{b) The apparent extent of the 
absorption is the extent of the 
infection. 

(c) An area of absorption, if 
present, can be disclosed by the 
roentgenogram. 



(a) Roentgenograms do not reveal infec- 
tion, and may or may not reveal its effects. 

(b) The extent of the absorption does not 
express the extent of the infection, except 
in part as that individual's reaction to the 
infection is understood. 

(c) An area of absorption of the support- 
ing tissue at the apex of a tooth, or laterally, 
may not be disclosed because of any of the 
following conditions; (1) Being hidden by 
a part of that tooth, such as another root; 
(2) A heavy mass of bone, such as the malar 
bone; (3) A layer of condensing osteitis ob- 
scuring the rarefying osteitis. 



NO. 2. BACTERIAL CAUSE. 



if dental infections produce 
disturbance in other parts of the 
body, it is because the organism 
that has chanced to invade that 
tissue is one having the specific 
qualities for that invasion and 
localization regardless of the 
host, much as the organisms of 
erysipelas and mumps will re- 
spectively select the skin and 
parotid gland. 



Dental infections involving root canals 
and their apices and supporting structures 
practically always contain streptococci, of 
which, biologically, there are many types 
or strains, any one of which may be the im- 
portant causative factor for any of the 
various types of rheumatic group lesions, 
regardless of biological classification. The 
elective localization and attacking qualities 
are developed by the environment and are, 
consequently, a factor of the soil or host. 






26 DENTALINFEC flONS & DEGENERATIVE DISEASES CLINICAL VOL. II 



()l I) l\ I I RPRI I \ l l()\s 



\l \N IVI I Kl'kl I VI IO\S 



NO. 3. LOCAL-ORAL-STRUCTURAL CHANGES. 



a) Dottal infection in bom 
will express itself as absorption. 

b A given dental infection 
iv ill express itself in I In local 
tissues of tin month approxi- 
mately the sann in all peopU . 



a Dental infection in bone may express 
itself as absorption, even extensive absorp- 
tion, or may be attended by very little or no 
absorption, or may even produce a marked 
increase in the density of the bone. 

(b) A given dental infection will not ex- 
press itself in the local tissues of the mouth 
approximately the same in all people. Peo- 
ple tend to divide into groups with regard 
to tbis matter of local reaction, which 
groups are very dissimilar. 

NO. 4. SYSTEMIC REACTIONS. ARE HUMAN BEINGS COMPARABLE? 



Human beings an similar in 
their susceptibility to reactions 
to dental infections, or suffi- 
ciently so, thai they may be con- 
sidi red comparable and lx judged 
bv tin sann standards. 



Human beings do not react with suffi- 
ciently uniform similarity to justify the 
premise that they can all be judged by the 
same standards and, therefore, may be con- 
sidered comparable in their susceptibility 
to systemic involvement from dental in- 
fections. They can, however, be divided 
into groups, the members of which are 
sufficiently similar to be judged by the 
same general standards, and they of that 
group may, therefore, be considered com- 
parable. On the basis of this quality ol 
susceptibility, they readily classify into 
three groups; namely, those with an in- 
herited susceptibility, those with an in- 
quired susceptibility, and those without a 
susceptibility to rheumatic group lesions. 

NO. 5. RELATIONSHIPS BETWEEN LOCAL AND SYSTEMIC 

EXPRESSIONS. 



Since, according to tin pre- 
sumption all individuals arc 
similar, and sine< dental infec- 
tions an entirely dependent for 
their characteristics upon tin 
t\pt of organism which has 
chanced t<> secun access, there- 
tlu u an no characU ristics 
m tin local tissm pathology 
which an related to tin <b grei oj 
susceptibility oi nature of sys- 
tt mic involvenn m. 



Local dental pathology about an infected 
tooth has variations which make grouping 
and classification easily possible on this 
basis, which groups have a direct relation- 
ship with similar groupings that can be 
made on the basis of susceptibility to rheu- 
matic group lesions. The local and sys- 
temic expressions are not only related, but 
are both symptoms of the same controlling 
forces and conditions. 



Ul \1\ l.\ 11 



INTRODUCTION 01 D \\h M.W 11 NDAMEN1 \l> 



OLD INTERPRETATIONS 



NEW INTERPRETATIONS 



NO. 6. VISIBLE ABSORPTION AND TOOTH INFECTION, 



(a) A tooth without risible ab- 
sorption at its apex is not in- 
fected. 

(b) A tooth with risible ab- 
sorption at its apex is infected. 



a Teeth without absorption at their 
apices can be, and frequently are, infected 
in the pulp, dentin, and apical tissue. 

(b) Teeth with periapical absorption can 
have the same produced by irritating medi- 
cation or trauma. 



NO. 7. CARIES AND PI LP INFECTION. 



Pulps of teeth not exposed by 
caries are not infected. 



Teeth with moderate caries frequently, 
and with deep caries generally, have their 
pulps already infected to some extent 
through this channel. 



NO. 8. PERIODONTOCLASIA AND PULP INFECTION. 



Pulps of teeth with pockets 
from periodontoclasia not in- 
volving the apex are not infected. 



Teeth with shallow or moderate pockets 
from periodontoclasia frequently, and with 
deep pockets from periodontoclasia usually, 
have their pulps already infected to some 
extent from that source. 



NO. 9. CARIES. AND SYSTEMIC INVOLVEMENT. 



There is no relationship be- 
tween caries and systemic in- 
volvements. 



Susceptibility to dental caries and sys- 
temic involvements from dental lesions 
are proportional, both as cause and effect 
and as related symptoms. 



NO. 10. PERIODONTOCLASIA AND SYSTEMIC INVOLVEMENT. 



With an increase of suscep- 
tibility to periodontoclasia, there 
is a marked increase in sus- 
ceptibility to rheumatic group 
lesions. 



Individuals with marked susceptibility 
to periodontoclasia have, as a group, a de- 
creased susceptibility to the rheumatic 
group lesions during the period of its active 
development (in its secondary stages it may 
contribute to rheumatic group lesions); or 
expressed otherwise, individuals with a 
very marked susceptibility to rheumatic 
group lesions tend, in general, to be free 
from extensive periodontoclasia; and when 
rheumatic susceptibility does develop, it 
would generally be classed as an acquired 
factor. 



28 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 



Oil) INTERPRETATIONS 



\l \\ INI ERPRETATIONS 



NO. 11. PERIODONTAL AM) APICAL REACTIONS. 



There is no relationship be- 
tween the extent of apical ab- 
sorption from a pulp involve- 
ment and the presence or ab- 
sence of a periodontal absorp- 
tion from a gingival irritation. 



There is a direct relationship between 
tendency to absorption of alveolar bone in 
response to irritation, whether at the gin- 
gival border or at the root apex ; and individ- 
uals with extensive periodontoclasia have, 
for a given dental infection, much more ex- 
tensive areas of absorption at the apices of 
infected roots, than do patients without a 
tendency to periodontoclasia. 



NO. 12. RELATION OF APICAL ABSORPTION TO DANGER. 



The quantity or extent of the 
absorption is a measure of the 
danger; or otherwise expressed, 
the size or extent of the disclosed 
area of absorption at the apex of 
the root of a tooth is directly an 
expression of the quantity of 
infection and, therefore, a mea- 
sure of the danger from it. 



Since different people react differently, 
through a wide range, to a given infection, 
the extent of the area of absorption is not a 
measure of the danger; but, on the contrary 
it may be, and frequently is true that the 
patient suffering severely from a systemic 
reaction caused by a dental infection shows 
very little absorption compared with that 
which the same dental infection would pro- 
duce in a patient with ample and high re- 
sistance. 



NO. 13. NATURE OF FISTULA DISCHARGE. 



Flowing pus from a fistula is, 
necessarily, very dangerous to 
the patient since it is an ex- 
pression of the quantity of local 
infection and, therefore, a mea- 
sure of the danger from it. 



Since an adequately active defense 
against a dental infection, both locally and 
systemically, produces a vigorous local re- 
action with attending extensive absorption 
and the products of inflammatory reaction, 
namely, exudate and plasma in sufficient 
quantity to require an overflow, usually 
spoken of as pus from a fistula, this over- 
flow may be, and usually is, evidence of an 
active defense and is constituted almost 
wholly of neutralized products and is often 
sterile, and such a condition is much more 
safe than the same infected tooth without 
such an active local reaction. 



CHAP. IA 111 INTRODUCTION >LD AND NEW FUNDAMENTALS 29 



OLD INTERPRETATIONS 



MAN IMI.KI'KI . I \ ll()\s 



NO. 14. ROOT CANAL MEDICATIONS. 



\a) Infected teeth can be ster- 
ilized readily by medication. 

[b) Usual medications do not 
injure the supporting structure. 



(a) Infected teeth can be completely ster- 
ilized in the mouth only with great diffi- 
culty, or by the use of medicaments whose 
irritability readily injures the vitality of the 
supporting structures of the teeth. 

(b) Many of the usual methods used for 
the sterilization of infected teeth do serious 
injury to the supporting structures about 
the teeth. 



NO. 15. ROOT CANAL FILLINGS. 



Root fillings fill pulp canals 
and continue to do so. 



Root fillings rarely fill pulp canals suffi- 
ciently perfectly to shut out bacteria, com- 
pletelyorpermanently. Root fillings usually 
fill the pulp canal much less perfectly 
some time after the operation, than at the 
time of the operation, due to the contrac- 
tion of the root-filling material. The ulti- 
mate volume contraction of the root filling 
is approximately the amount of solvent 
used where a solvent is used with gutta- 
percha as a root-filling material. Infection 
is a relative matter, and quantity and 
danger are both related to defense, which 
defense may vary from high to exceedingly 
low. 



NO. 16. COMFORT AS A SYMPTOM. 



Local comfort and efficiency 
of treated teeth are an evidence 
and measure of the success of 
an operation. 



Local comfort not only is not a certain 
index of success or safety, but may consti- 
tute both what is probably one of the great- 
est paradoxes and one of the costliest diag- 
nostic mistakes through injury to health, 
that exists in both dental and medical 
practice, because it may only mean the 
absence of local reaction which would, if 
present, incidentally make the tooth sore 
and fundamentally destroy the infection 
at its source whereas, the absence of this 
local reaction and its consequent destruc- 
tion of the infection products, permits 
them to pass throughout the body to irri- 
tate and break down that patient's most 
susceptible tissue, which tissue can be an- 
ticipated very frequently, if not generally. 



30 DENTALINFEC riONS & DEGENERATIVE DISEASES CLINICAL VOL.11 
OLD INTERPRETATIONS M.u INTERPRETATIONS 

NO. 17. CAPACITY FOR INFECTION OF ROOT-FILLED TEETH 

When infected teeth product When infected teeth produce disturbance 

disturbance in other parts of the in other parts of the body, it is not neces- 
body, it is primarily because the sary that the quantity of infection be large, 
patient is overwhelmed by a nor is it demonstrated that it is necessar\ 
lur»c quantity of infection. that organisms always pass throughout the 

body or to the special tissues involved, but 
the evidence at hand strongly suggests that 
soluble poisons may pass from the infected 
teeth to the lymph or blood circulation, or 
both, and produce systemic disturbances 
entirely out of proportion to the quantity 
of poison involved. The evidence indicates 
that this toxic substance may, under cer- 
tain conditions, sensitize the body or spe- 
cial tissues, so that very small quantities 
of the toxin or of the organisms which pro- 
duce it, may produce very marked reactions 
and disturbances in that tissue. 

The preceding research problems cover the fundamentals that 
have been in general consideration in problems of dental diag- 
nosis, prognosis, and treatment. My researches upon them have 
opened up many additional problems, twenty-seven of which I 
have presented in the latter part of the preceding chapters. There 
cannot, therefore, be given for these latter problems, an old and 
;i new interpretation. I will, accordingly, present herewith, some 
general interpretations growing out of the general applications 
and later researches, and in place of the statement of the problem 
as an old fundamental in the left-hand column, as in the first 
seventeen chapters, will simply state the problem. 

NEW PROBLEMS 

NO. 18. STUDIES OF PI LPLESS TEETH. 

I luri pulphss teeth injurious Infected teeth may contain in addition to 

contents olhei than microor- microorganisms toxic substances, which 
. auisH/s? produce very profound effects upon experi- 

mental animals, and which tend to prepare 
the tissues of the host, at least in some 
cases, for a more ready invasion by the or- 
ganisms growing in that tooth. 



CHAP.LVIIl INTRODUCTION OLD AND NEW FUNDAMENTALS 31 
NEW PROBLEMS NEW INTERPRETATIONS 

NO. 1 ( ). HEMATOLOGICAL CHANGES IN THE BLOOD. 

What changes arc produced in Dental infections may produce very se- 

the blood and sera of the body rious changes in the blood and sera of the 
by denial infections? body, some of the most frequent of which 

are leucopenia, erythropenia, lymphocyto- 
sis, and hemophilia. 

NO. 20. CHEMICAL CHANGES OF THE BLOOD. 

What are the chemical changes Dental focal infections tend to produce, 

that are produced in the blood in many instances, one or several chemical 
by acute and chronic dental focal changes in the blood, which changes tend 
infections? also to be produced in animals when an in- 

fected tooth is placed beneath its skin, and, 
„ similarly, with certain methods of inocula- 
tion with the culture grown from these 
teeth. Some of the changes most fre- 
quently found involve: 

(a) The ionic calcium of the blood. 

(b) The presence of a pathologically com- 
bined quantity of calcium in the blood. 

(c) A reduction of the alkali reserve of the 
blood. 

id) The development of acidosis. 

(e) An increase in the blood sugar. 

f) An increase in the uric acid. 

(g) The development of nitrogen reten- 
tion. 

(h) The development of products of im- 
perfect oxidation. 

NO. 21. CONTRIBUTING OVERLOADS WHICH MODIFY DEFENSIVE 

FACTORS. 

What are the contributing fac- Dental infections, while potentially harm- 

tors causing a break in resist- ful, may not be causing apparent or serious 
ance? injury until the individual is subjected to 

some other overload, at which time a se- 
rious break may come. The chief contrib- 
uting overloads are influenza, pregnancy, 
lactation, malnutrition, exposure, grief, 
worry, fear, heredity, and age. 



32 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINK Al. VOL. II 
NEW PROBLEMS NEW INTERPRE1 \IK)\s 

\(). 22. ELECTIVE LOCALIZATION AND TISSUE AND ORGAN 
SUSCEPTIBILITY PHENOMENA. 

Do the organisms of dental Dental infections may or may not con- 

infeciions possess or acquire lis- tain organisms with a specific elective local- 
sue affinity and elective local- ization quality for certain tissues of the 
ization qualities? body. When they do so it is generally be- 

cause the host is suffering, or has pre- 
viously suffered, from an acute process in 
that tissue, which acute process frequently, 
entirely and permanently, disappears with 
the removal of the focus of infection. There 
is evidence to indicate that the complete 
removal of an organ so affected does not 
destroy that elective localization quality 
in the microorganisms of the focus. De- 
fense and absence of defense to strepto- 
coccal infection as an organ and tissue 
quality, seems definitely to be related to 
inheritance and, as such, obeys the laws of 
mendelian characteristics. 

NO. 21. ENVIRONMENT PRODUCED BY INFECTED PI LPLESS TOOTH. 

What are tin characteristics Since an infected tooth is a fortress for 

of tin habitat and environment bacteria within the tissues of the host, and 
furnished for bacteria in an in- since, in accordance with the laws govern- 
fected pulpless tooth? ing the behavior of solvents and solutes, 

the dissolved substances within the tooth 
can pass to the outside of it, and, similarly, 
the dissolved substances outside the tooth 
can pass to the inside of it, together with 
the fact that the defensive mechanisms of 
the body are quite unable to enter and 
reach the bacteria within the tooth except 
in exceedingly small numbers through the 
natural openings of the root, which open- 
ings will, however, permit the organisms 
to pass at will from within the tooth to the 
outside, we must conclude that an infected 
tooth furnishes a condition and environ- 
ment that is tremendously in favor of the 
invading organism inhabiting it, as com- 
pared with the host, since the latter may 
only rid itself of the menace by exfoliating 
it or absorbing it. 



CHAP. I.YIII— INTRODUCTION— OLD AND NKW I- 1 XDAMKN I \I.S 33 
NEW PROBLEMS NKW INTERPRETATIONS 

NO. 24. ELECTIVE LOCALIZATION AND ORGAN DEFENSE. 

Do diseased organs and lis- We are led to conclude from the available 

sues modify bacteria growing data, that we do not as yet have sufficient 
in the distant focus, or create information to draw a close distinction be- 
in them a capacity for local- tween the influences of the organisms on 
ization for those diseased tissues? the affected organ, in contradistinction to 

the influences of the diseased organ upon 
the organisms in the focus. The available 
data suggest strongly, if they do not def- 
initely indicate, that both these conditions 
exist, in some instances, either one acting 
entirely alone, and in some others there are 
indications that both exist at the same 
time. 

NO. 25. RELATION OF IRRITANT TO TYPE OF REACTION. 

Have we different products The evidence available indicates that in- 

from dental infection? fected teeth elaborate two distinctly dif- 

ferent products, one being bacteria, and 
the other a toxic substance or group of 
toxic substances, which, independently of 
the organisms developing them, may pro- 
duce various and profound disturbances 
in tissues in various parts of the body, one 
of the important group of disturbances 
being that of the blood stream. 

NO. 26. CHEMOTAXIS AS A MEANS FOR INCREASING DEFENSE. 

Can defense for streptococcal These preliminary experiments would 

infections be increased by intro- seem to suggest that, means can be de- 
ducing enterally or parenterally veloped which will effectually assist, by 
(by ingesting or injecting) chem- chemical means in the defense of the body 
icals? against the invading streptococcal organ- 

isms of dental origin or from other sources 
which produce the rheumatic group le- 
sions. 

NO. 27. THE EFFECT OF RADIATION ON DENTAL PATHOLOGICAL 

LESIONS. 

Can periodontoclasia and api- (a) These three forms of radiation- 

cal abscess and inflammation namely, Roentgen-ray, radium radiation, 

be cured by various types of and ultraviolet as generated from mercury 

radiation? vapor and quartz tube have definite effect 



34 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 
NEW PROBLEMS \l \\ l\ I Kl I'kl I \ l IONS 

on cell resistance and proliferation, and 
thus directly upon tissue reaction expres- 
sions such as pus, bacterial invasion, and 
granulation. 

ib Some of these forces are apparently 
definitely harmful; others are apparently 
definitely helpful. 

NO. 28. GINGIVAL INFECTIONS, THEIR PATHOLOGY AND 

SIGNIFICANCE. 

Are the present theories re- < a) Inflammatory processes of the tissues 

garding the etiology of periodon- about the teeth are a direct expression, and 
toclasia, or so-called pyorrhea therefore a measure of the vital capacity 
alveolar is, eorreet'^ for reaction of that individual to an irri- 

tant, during those stages of these lesions, 
characterized by an abnormally high vital 
reaction. 

(b) The individual, who has had this ca- 
pacity for a very active reaction to the pres- 
ence of irritants, may pass into a condition 
or state in which he or she has lost that 
high defensive factor, at which time sev- 
eral changes develop including a cessation 
of the absorption of alveolar bone, a lower- 
ing of the alkalinity of the periodonto- 
clasia pockets, a change in their bacterial 
flora, all of which may provide under these 
later conditions a focus for systemic infec- 
tion of the most dangerous type, though 
they may have ceased to have evidence 
either of local inflammatory disturbance, 
or exudate as pus. 

(O To the ordinary observer, lay or pro- 
fessional, these two very dissimilar states 
are considered to be similar or identical 
though they are potentially very different. 
id) These different peridental expressions 
or reactions to irritations are accompanied 
by, and doubtless related to, changes in the 
ionic calcium and alkali reserve of the 
blood. 

NO. 2<). ETIOLOGICAL FACTORS IN DENTAL CARIES. 

What are the dominant etio- Dental caries is dependent upon the fol- 

logical factors in dental caries? lowing factors: 



CHAP. LVIII- INTRODUCTION -OLD AND \l \\ II NDAMKN1 MS 35 
NEW PROBLEMS NEW INTERPRET \ I IONS 

(a) A reduction in the hydrogen ion con- 
centration of the normal environment of 
the tooth. 

(b) An acid producing bacterium. 

(c) A change in the chemical constituents 
of the pabulum bathing the tooth. 

NO. 39. THE NATURE OF SENSITIZATION REACTIONS. 

Do dental injections produce (a) Teeth contain substances other than 

sensitizations of an anaphyl- bacteria to which the individual may be- 
actic character? come sensitized, and which substances 

may, in addition, have strong toxic prop- 
erties. 

(b) The evidence here presented suggests 
that dental infections are capable of pro- 
ducing in an individual a state of anaphyl- 
actic sensitization, which condition may 
entirely and apparently permanently dis- 
appear with the removal of the dental in- 
fections. These disturbances may occur 
in dermal tissues, mucous membranes of 
the nose and throat, lacrimal tissues, mu- 
cous membranes of the bronchioles and air 
passages, as asthma, and the mucous mem- 
branes of the digestive tract and a number 
of other types of tissues. 

NO. 31. PRECANCEROUS SKIN IRRITATIONS. 

Are there relationships between The evidence available suggests: 

precancerous skin irritations and (a) That dental infections may produce 

dental infections? localized anaphylactic reactions, as irrita- 

tions of the skin and mucous membranes. 
(b) That these sensitizations may de- 
velop into precancerous conditions. 

NO. 32. DENTAL INFECTIONS AND CARBOHYDRATE METABOLISM. 

What, if any, is the relation- Dental infections may produce marked 

ship between dental infections changes in carbohydrate metabolism and 
and carbohydrate metabolism? probably structural and degenerative 

changes in the islets of Langerhans of the 
pancreas, with the production of hyper- 
glycemia and glycosuria. 



36 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINK VI VOL.11 



NEW PROBLEMS 



\I-.W INTERPRETATIONS 



NO. 33. MARASMUS. 



Why do /}(o/)lc with rheu- 
matic group lesions lend to be 
underweight? 



Dental infections, when they affect the 
patient systemically, frequently, if not gen- 
erally, produce a depression of the individ- 
ual's weight; and marasmus, whether 
mild or severe, may be considered one of 
the diagnostic symptoms in studying the 
relation of dental infections to general 
health. 



NO. 34. PREGNANCY COMPLICATIONS. 



Do denial infections hare a 
bearing on pregnancy complica- 
tions? 



(a) These researches have shown that in 
animals, infections from dental origin may 
have a very far-reaching effect on each the 
expectant mother and her fetus, which 
latter may be prematurely expelled or may 
be rendered lifeless. 

(b) Inasmuch as a large number of our 
serious cases of rheumatism, heart, and 
kidney involvements, have their origin at 
the time of pregnancy in humans, in which 
cases our clinical histories show that there 
have been present extensive dental focal 
infections, it is suggested as important, if 
not imperative, that expectant mothers 
shall be free from dental focal infections, 
both for their own safety and efficiency and 
for the continued vitality of the fetus. 



NO. 35. SPIROCHETE AND AMEBA INFECTIONS. 



Do organisms other than strep- 
tococci enter the human system 
through dental infections? 



While the streptococcus seems universally 
to be present in dental infections in prac- 
tically all cases of systemic involvement, in 
addition to this variety the evidence seems 
to establish that each staphylococci and 
spirochetes may pass from infected teeth 
to other tissues and proliferate in localized 
areas; and, similarly, that when certain 
mixed strains are injected into experi- 
mental animals, localized spirochete in- 
fections may develop in their tissues. Sys- 
temic involvements from spirochete infec- 
tions and their localization in experimental 
animals are, however, relatively rare. 



CHAP. LVIII— INTRODUCTION OLD AND NE^ FUNDAMENTALS 'M 



NEW PROBLEMS 



NEW INTERPRETATIONS 



NO. 36. NUTRITION AND RESISTANCE TO INFECTION. 



What is the relation of nutri- 
tion to resistance to dental in- 
fection? 



The data at hand suggest: 

(a) That the effects of variations in the 
diet do not express themselves quickly in 
specific defense. 

(b) That variations in diet by the limita- 
tion of various vitamines produces effects 
which, in general, are similar to those of 
overload. 

(c) Deficiency diets, particularly disturb- 
ances resulting in a calcium hunger, tend 
directly to lower the defense to dental in- 
fections. 



NO. 37. THE RELATION OF THE GLANDS OF INTERNAL SECRETION 
TO DENTAL INFECTIONS AND DEVELOPMENTAL PROCESSES. 



What is the relation of the 
glands of internal secretion to 
dental infections in develop- 
mental processes? 



We would summarize these studies as 
follows : 

(a) Disfunctions of various of the glands 
of internal secretion are often very ma- 
terially corrected, and sometimes com- 
pletely so, by the removal of dental focal 
infections. 

(b) Involvements have frequently been 
produced in similar endocrine tissues of 
the animals by inoculating them with the 
cultures from the teeth of the involved pa- 
tients. 

(c) The administration of the extracts of 
the glands of internal secretion, particularly 
of the parathyroid, is shown to be of dis- 
tinct benefit in certain cases of depressed 
ionic calcium of the blood, due in part to 
dental focal infections, where this improve- 
ment has been absent or slow following the 
removal of the dental infections. 

(d) An improvement has been produced 
in individuals, which we interpret to be due 
to a stimulation of the pituitary body, 
which in turn doubtless stimulates other 
ductless glands and together with them 
produces a marked change in both physical 
and mental states. 



38 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 
NEW PROBLEMS NEW INTERPRETATIONS 

NO. 38. THE NATURE AND FUNCTION OF THE DENTAL GRANULOMA. 

Is the dental granuloma a pus (a) The so-called granuloma is a mis- 

sac and its size a measure of nomer, for it is a defensive membrane and 
the danger? not a neoplasm. 

(b) A normally functioning periapical 
quarantine tissue is Nature's effective 
mechanism for protecting that individual 
by destroying the organisms and toxins 
immediately at their source, and thereby 
completely prevent the tissues of that 
individual's body from exposure to either 
of these agencies. 

NO. 39. CHANGES IN THE SUPPORTING STRUCTURES OF THE 
TEETH, DUE TO INFECTION AND IRRITATION PROCESSES. 

What are the changes pro- Characteristic localized structural 

duccd in the supporting struc- changes develop in the supporting struc- 
tures of the teeth, which are due tures of teeth when the latter carry infec- 
to infection and irritation proc- tion within their structures. These changes 
esses? are, however, determined chiefly by the 

host and are an expression of the reacting 
characteristics of the host rather than an 
expression of the invading bacterium. 

NO. 40. DENTAL INVOLVEMENTS CAUSED BY ARTHRITIS. 

Can arthritic infections of (a) It will be seen from these data that a 

the body attack and devitalize systemic involvement of multiple arthritis 
the teeth? may, while attacking various joints of the 

body, also attack those of the joints of the 
teeth; and, further, that this process of 
inflammation with degenerative and pro- 
liferative processes may cause the involve- 
ment and ultimate death of the pulp. 

(b) The involvement of these teeth as a 
result of the progressive systemic arthritis 
may in turn, and doubtless frequently, if 
not generally, does aggravate the general 
condition, for the tooth structure when it 
becomes infected is even less capable of 
vascularization and therefore less amen- 
able to the processes of defense than is bone. 
This stresses the very great importance 
that individuals having deforming arthritis 
shall have most careful dental inspection 



CHAP. LVIII— INTRODUCTION— OLD AND NKW FUNDAMENTALS 39 
NEW PROBLEMS NEW INTERPRETATIONS 

and care, and also, since it is one of the 
most horrible of living deaths, every effort 
should be made to prevent the beginning 
of that process; and since the evidence is 
so overwhelming that the initial infection 
frequently, if not generally, comes from 
the teeth, helpless humanity deserves pity 
until the powers that be shall make a 
worthy effort to find the means that will 
prevent this needless catastrophe in so 
many lives. 

NO. 41. VARIATIONS IN THE DEFENSIVE FACTORS OF THE BLOOD. 

Is there a difference in the There is a marked difference, which is 

defensive factors of the blood of readily measurable in the bactericidal 
susceptible and non-susceptible properties of the bloods of individuals of 
individuals to systemic involve- high defense, as compared with those of 
ments from dental infections? low defense to systemic involvements from 

dental infections. 

NO. 42. METHODS FOR REINFORCING A DEFICIENT DEFENSE. 

Can a temporarily or per- In some individuals a low defense may be 

manently low defense against materially strengthened by the use of vac- 

the streptococci of dental infec- cines and also by the use of all available 

tions be increased or enhanced means for stimulating metabolism and in- 

either temporarily or perma- creasing a supply of essential nutritional 

nently? factors. 

NO. 43. SEROPHYTIC MICROORGANISMS. 

What are the growth factors When the mixed flora of the oral cavity 

of microorganisms of the mouth are planted in the normal blood serum or 
in juices of living tissues? lymph, the varieties that grow are almost 

entirely limited to the strains of diplo- and 
strepto-cocci, with occasional staphylo- 
cocci, with the diplo- and strepto-cocci 
largely predominating. 

NO. 44. CALCIUM AND ACID-ALKALI BALANCE. 

What is the role of calcium to In the proper functioning of the body, 

the maintenance of the acid- the end products of metabolism are carbon 
alkali balance of the blood, other dioxide, urea, and water. When metabolic 
body fluids, and tissues? functions are abnormal, resulting in the 

imperfect oxidation with the development 
of less simple acids than carbon dioxide, 



40 DENTAL INFECTIONS* DEGENERATIVE DISEASES CLINICAL VOL. II 



NEW I'ROIU.I.MS 



NEW INTERPRETATIONS 

these must be neutralized with bases taken 
from the body and its fluids. In the ab- 
sence of an adequate supply of these from 
other sources, the demand must be met by 
the calcium of the body, first from the cir- 
culating ionic calcium, then from the cal- 
cified tissues. This latter is the character- 
istic end reaction involved in periodonto- 
clasia, or pyorrhea alveolaris. This enters 
into and complicates the etiology of many, 
if not most, of the rheumatic group dis- 
turbances studied in detail in subsequent 
chapters. 



NO. 45. SYMPTOMS AND DANGER. 



Since individuals are similar 
in their reactions to dental in- 
fections, both locally and sys- 
temically, and since freedom 
from involvements is depend- 
able, the danger is proportional 
to the quantity and to the type 
or viru 1 cncc of the dental infec- 
tion involved and the patient's 
symptoms. 



Since patients largely determine the bio- 
logical qualities of the organisms involved 
in dental infections by the culture medium 
they furnish the bacteria, and since the 
sufficiently high defense of certain indi- 
viduals will, under ordinary conditions, 
protect them from systemic injury result- 
ing from their dental infections, and since 
the local oral expressions of the dental in- 
fection are an indication and a measure of 
that individual's reaction to the dental 
infection rather than a measure of that 
infection, therefore, it becomes apparent 
that the operation that is indicated is an 
individual factor and concerns the relation 
of the efficiency of the patient's defense to 
the attacking power of the dental infections 
and, accordingly, operations which are 
strongly indicated for some individuals are 
as strongly contraindicated for others. 



NO. 46. DIAGNOSIS. 



An adequate procedure for 
making dental diagnosis is a 
roentgenograph^ study of the 
patient, for which the only req- 
uisite training is a working 
knowledge of the apparatus and 
a familiarity with dental anat- 
omy sufficient properly to call 
tin teeth by their uann s. 



An adequate procedure for making a 
dental diagnosis will involve, as a mini- 
mum, the following: 

A knowledge of the patient's systemic 
defense and systemic involvements, both 
present and past. The securing of this will 
involve: 

(a) A knowledge of the various systemic 
disturbances that may be produced or ag- 



CHAP, mil- -INTRODUCTION OLD AND NEW I'l NDAMEN1 \l S 



II 



NEW PROHI.KMS 



NEW IN [ERPRETATIONS 

gravated by the dental infection, with or 
without the patient's recognition of their 
existence. A knowledge of the systemic dis- 
turbances includes, for differentiating pur- 
poses, a knowledge of the etiological pa- 
thology of the involved tissues of most of the 
morbid conditions of the human body, re- 
gardless of the type of tissue or the involved 
nature of the functions. These are based 
upon a thorough knowledge of the gross 
and minute anatomy of the various organs 
and tissues of the body, and the normal 
functions of those tissues, with special 
reference to the nervous system. 

(b) A roentgenographs study, with a 
knowledge that it is physically impossible 
for the Roentgen-rays to disclose much of 
the essential information, the roentgeno- 
gram being simply a record of relative total 
densities of the planes involved. 

(c) A familiarity with the use of the mi- 
croscope and such laboratory technique as 
serological study of the fluids of the body, 
since many of the lesions, being produced 
or aggravated by dental infections, are in 
evidence by microscopic and chemical 
methods long before they appear clinically 
as symptoms. 

NO. 47. DIAGNOSTICIANS. 



Dental diagnosis is so simple 
that any dentist or physician, 
osteopath, chiropractor, elec- 
trical engineer, or laboratory as- 
sistant, is competent to perform 
this simple service. 



Dental diagnosis is so intricate and in- 
volved that it requires a greater knowledge 
of the human body, its structure and dis- 
eases, and of the various means for under- 
standing the normality and abnormality 
of the same, than any specialty of the heal- 
ing arts; and probably no specialty finds 
such great opportunity for doing injury to 
humanity, or for extending human life, as 
does the highest application of intelligence 
in this field. A competent diagnostician of 
the local and systemic expressions of dental 
infections must be familiar with the clini- 
cal and structural pathology required for a 
general medical diagnosis, and, in addition, 
be completely familiar with each dental 
anatomy, dental pathology, and dental 
operative procedure. 



42 I 'I.N l \I. INFECTIONS & DEGENERATIVE DISEASES -CLINICAL VOL. II 

There are many phases of these problems that are very in- 
volved. Few dentists realize the advantage of preventing the 
development of a lesion over undertaking its correction or cure, 
not appreciating that lesions of the central nervous system, that 
have existed for two years or more, are generally irreparable; and 
similarly, many lesions of the kidneys, when once established, 
constitute a permanent and often progressive disfunction. It is, 
therefore, often too late when the psychosis, atrophy, or nephritis 
is discovered. This also is particularly true of heart lesions. 
The knowledge of these facts, then, becomes fundamental for an 
efficient prophylactic sense. This does not mean that in the 
absence of a basis for judgment, all teeth should be extracted. 
This constitutes one of the gravest of tragedies, since to add to a 
permanent deformity and handicap that of a living permanent 
cripple is a needless double curse and a reproach to the very name 
and spirit of the healing sciences. The purpose of these chapters 
is to illustrate not only that dental infections produce degener- 
ative diseases, but that the removal of only the involved teeth pro- 
duces the relief being sought. 



CHAPTER LIX. 

APPLICATION OF PRECEDING EXPERIMENTAL DATA 
IN CLINICAL PRACTICE. 

DISCUSSION. 

In no part of dental practice does the value and significance of 
these new data have so great an importance as in the nature of 
treatment and procedure, for an intelligent application of these 
fundamentals will not only conserve innumerable good teeth 
which are now being ruthlessly and needlessly sacrificed, but 
cause the removal of other innumerable teeth now being entirely 
overlooked or being passed as not having sufficient evidence of 
pathology. If, as I am personally convinced, an individual with 
a marked susceptibility to heart involvement will tend to have 
the same irritated by the presence of even a small quantity of 
locked dental infection, it is not safe or wise for that patient to 
have that small quantity unless we can find a condition in which 
the service of the involved tooth is so great to that individual that 
he or she will be done more harm by its removal than by that 
infection, which condition rarely exists, since a properly function- 
ing heart is so fundamental not only to life itself but to comfort 
and efficiency of living, for a body cannot function without a 
functioning heart. And this is quite as true of kidney. 

As we have shown, pulpless teeth, even when root filled, can 
become (and I believe ultimately generally do become) infected, 
because every tooth may contain approximately five per cent 
culture medium, even after root filling, unless something has been 
done, which as yet I have not had evidence can with confidence be 
accomplished, efficiently to establish a condition in which neither 
organisms nor degeneration products of tooth tissues can develop. 
If, then, a given patient can be shown to have an abnormally low 
capacity for establishing and maintaining a defensive quarantine 
about every root-filled tooth, and if he or she has a definite sus- 
ceptibility to an involvement of a vital organ such as heart or 
kidney, it is my judgment that for that patient pulpless teeth 
should be extracted, or if filled, should be most carefully watched; 
and I do not know of any means for ascertaining whether a tooth 

43 



44 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

in that type of patient is approaching a condition of danger after 
it is treated and root-filled because of that failure to react. 

If, on the other hand, the patient in question can be shown to 
have the ability to establish an adequately efficient defense and 
quarantine about even a highly infected tooth or teeth to keep 
that patient entirely safe, it is my opinion that if a tooth without 
extensive infection is valuable to that patient and if the peridental 
membrane has not been seriously involved but the pulp is en- 
dangered either from mechanical injury or deep caries, that pulp 
may be removed under certain conditions and the root fillings may 
be placed ( if such can be done from a mechanical standpoint with 
very great thoroughness) and produce a condition which will be 
relatively safe for that patient during the time that he or she 
has that relatively high defense. I believe, however, that it is 
true that such a patient's high defense will keep him safe not only 
because of our dental procedure but in spite of anything that we 
can possibly do to that tooth. Such a safety on the part of the 
patient will be due almost entirely to the fact of his or her high 
defense and not because any operator is capable of placing that 
tooth in a condition in which it could never become infected. In 
other words, I believe practically all root-filled teeth, for this has 
been the result of my extensive studies, sooner or later (and with 
most very soon) contain organisms, though in the case of the type 
of patient we are considering with high defense, not in such quan- 
tities as are capable of producing toxic substances or organisms 
capable of invading that individual; for these, as they develop, are 
efficiently combated immediately surrounding the tooth. Since, 
however, we can never know when overload will strike even these 
individuals, such as influenza, grief, physical and nervous strain, 
etc., we must be very guarded in presuming that these individuals 
will always have that high defense. 

And, further, the age of the patient tends largely to determine 
that factor of safety; for just as a cannon ball is fired out over the 
sea and rises higher and higher to its maximum elevation, it can 
be known that ultimately and soon it must start to come down. 
and as it starts to come down, the beginning of the end of that 
flight has begun. And similarly, we must look upon all individ- 
uals beyond middle life, regardless of their defense, as approach- 
ing the time when that defense must of necessity diminish, and 
we are not justified in taking the same chances that we could 
when their defense was normally high and there was a prospect of 



CHAP. I. IX -APPLICATION OF EXPERIMENTAL TO CLINICA1 15 

its remaining so for some time. In other words, all root-filled teeth 
should, in my judgment, be considered under suspicion or at least 
under observation and should be checked up frequently and regu- 
larly if that patient's best interest is to be concerned; for, as we 
will see, there are many forms of systemic disturbance which may 
be aggravated, if not directly produced, by these dental infections 
which we have not so considered. The severity of the systemic 
expression and the contributing factors,— namely, dental infec- 
tion and contributing overloads,— must all be considered in 
deciding what type of operation may be made in a given case. 

I can best illustrate my interpretation of the best procedure 
and treatment in each of these types of cases by reviewing the 
case histories and applying these principles and presenting with 
each the research data such as elective localization of these 
strains in animals, serological and bacteriological studies on both 
the animals and patient, and the after-history, for it has not been 
possible for us to come to these conclusions except in the light of 
the fundamental results obtained in clinical practice. 

Before taking up in detail the clinical study and pathological 
conditions of the body and their relations to dental infections 
under the various groupings, it will be to our advantage to review 
a typical case with the application of these general principles. We 
are coming to find by experience that a large number of heart 
cases may have a much better prognosis than the general experi- 
ence with hearts would suggest. They seem to be in a state of 
very acute irritation, with the production of symptoms quite 
similar to, if not identical with, those of acute endocarditis. And 
probably in no specialty of medicine is it more important that 
these trusted with the chief responsibility of that part of the 
body shall use preventive programs; and, above all, that they 
shall not create, let alone maintain, the type of focal lesion which 
wall make possible the development of the irritant for these sensi- 
tive and already injured hearts. Their sensitiveness is often, 
however, our fundamental danger. The injury that has already 
been done to a valve cusp may have been largely compensated by 
Nature. Such a case is the following : 

Case No. 383. — The patient at the time she presented, five 
years ago, was twenty-three years of age. She had been inca- 
pacitated from her work by lassitude, shortness of breath, and 
acute rheumatism. Her net weight was 131 pounds, height 5 feet 
7> 4 inches. Family conditions made it necessary for her to work 
if at all possible. 



16 DENTAL INFEC I IONS& DEGENERATIVE DISEASES ( LINICAL VOL. II 




Figure 2tiA. Roentgenographic appearance of teeth of Case No. 385. 



Ker dental conditions are shown in Figure 263. An examina- 
tion of her teeth shows that the pulps are vital in the upper right 
first and second molars, and upper left molars; non-vital without 
root filling, upper right lateral; root filling with limited periapical 
absorption, upper left central. I hope the dental readers of this 
text at this point will visualize what they would do with such a 
case in their own practice before following my interpretation of 
what should be done and the description of the program carried 
out. Is it not true that in a person twenty-three years of age 
with vital pulps you would be disposed to put gold crowns on 
these molar teeth after removing the caries; and if the pulps were 
found exposed, proceed to root-fill? Since there is very little 
suggested trouble with the lateral, it would readily be taken care 
of by root filling. I will venture to guess that the great majority 
of the members of the dental profession would carry out a pro- 
gram without extraction of the above named teeth. 

But let us study her case a little farther. What is the shape of 
the roots of these upper molars? Are you sure you could fill 
around the angles? Or have they angles? Figure 264 shows 




Figure 264. Photographic appearance of extracted 
teeth of Case No. 385. (See Figure 263.) 

photographs of these extracted molars; and it is very certain 
that no dentist could, with certainty, place fillings in these molar 
roots that would fill in the sense that we understand root fillings 
should. 

This reminds me that one time at a dental convention a dentist 
made the bold assertion that he could fill 95 per cent of molar 
roots perfectly to the apex. A discussion arose and his ability was 
questioned; not that he was less competent, but even assuming 
that he was more competent, than the average. It was finally 
decided that I should select a quantity of molars and send them 
to him invested in plaster-of-Faris. He was to root-fill them and 
send them back. That would be an interesting illustration to 
insert here, but it is aside from the purpose of this volume. Suffice 
it to say that he did not have 5 per cent of them properly filled to 
the apices, and in about 25 per cent he penetrated the root walls; 
this, notwithstanding the fact that green teeth were used and the 
plaster in which they were embedded was kept moistened. 

But why root-fill teeth whose pulps are not definitely exposed? 
And, particularly in young persons, why not place gold crowns on 
these teeth "until they give trouble"? We have cultured a large 
number of pulps of teeth with deep caries and practically always 
find those pulps infected; and in other chapters we have illus- 
trated the production of acute rheumatism in animals with the 
cultures taken from pulps of such teeth, and which patients were 
already suffering from acute heart involvement. 

But this clearly suggests that we must have a basis of discrimi- 
nation, for certainly many pulps can and will remain vital if 
properly, protected and such teeth may give very important serv- 

47 



48 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

ice for a long period of time. In other words, it is true that for 
many patients teeth like the above are more valuable in the pa- 
t ient's mouth than out, all interests of their lives concerned. But 
here we are dealing with a different type of patient from the above 
and I have discussed this from this viewpoint in order that I might 
stress the great advantage in having a resistance and susceptibility 
chart for every case in which we have to make so important a 
decision, in order that we may evaluate that patient's factor of 
safety, for his or her teeth are only valuable in accordance with 
their safety from an injury to their health, which would far out- 
weigh the great advantage of retaining the service of the tooth in 
question. 

Figure 265 shows the susceptibility chart for this patient. It will 
immediately be noted that even at twenty-three years of age she 
has been breaking seriously as rheumatism and heart, digestive 
tract and nervous system. As stated, she has been incapacitated 
from her work for several months because of shortening of breath, 
(signifying her heart irritation), lassitude, and painful rheuma- 
tism. Immediately we see that this patient must have had either 
a very serious overload to produce an acquired susceptibility in 
these various tissues, a symptom group which is very unlikely 
to occur since acquired lesions are so largely in the nervous sys- 
tem, or she must have had a very marked inherited susceptibility 
or naturally low defense for this type of infection. 

To determine the latter we will look to her brothers and sisters 
who have the same sources of defense. She has two brothers and 
three sisters, all five of whom have had acute rheumatism; and 
one brother and two sisters have had heart involvement. This 
suggests immediately that they, too, must have had either a 
marked susceptibility or a very unusual overload. A study of her 
father and his immediate relatives shows that he was an invalid 
with heart involvement, with recurring attacks of rheumatism. 
He had not been able to do much more than half a man's work for 
main years and for long periods had been virtually an invalid. 
He has since died, at the age of fifty-seven, of acute heart involve- 
ment after a protracted bedridden illness. The father's mother 
died also of heart involvement with dropsy as an expression. 
The father's sister is an invalid at this time with heart involve- 
ment and hypertension, nephritis, and acute rheumatism, and has 
had one stroke at sixty-two years of age. On the other side of 
the ancestry we find this patient's mother died at fifty years 
of age of malignant endocarditis, about two years before the 



CHAP. l.IX APPLICATION OF EXPERIMENTAL TO CLINK \i 



1!) 



Private Records of Weston A. Price. M.S.. O.D.S.. 8926 Euclid Avenue. Cleveland. Ohio 





RESISTANCE AND 


suscepi imi i Fy'ci 

...MM. x - ; 
















1' 


1 \ RT 


< 3 

15';s c 

-•0 T' = 


A 


DURESS 


DAT1 




Chief Complaint ^ euryl(l 


t£ 








: 


Rheumatic <Troi p 

Lesions \m> 

Complic VTIONS 




OWN 


!• i l III n- --iiM 


Mothers Side 


■ 




7: 


j i — — 




i*> ~ * — 


> 


i 

4 
3 
« 
T 
■ 
• 




i 


7 \n a 


- 
■ 


- 




/ 












3 3 1 


/ i 












IO 
1 1 




; 


Tonsillitis 


* 4f i 


+? 














Rheumatism 


=tf* 3 






it 


# 






i« 

1 s 

IB 






Swollen or Deformed Joints 
























Neck-back or Sh< m 




1 












1 T 
IS 

1 O 

ao 

a i 






Lumbago 


* 


* 






r~ 






Neuritis 


+< 
















Sensitizations A «fk-»««: 


* 








k 




32 

23 
34 

as 

ae 

27 

a« 
aa 

30 
3 1 
32 














Sciatica 












I 












Chorea or St. Vitus's Dance 




















Nervous breakdown 


+ 


+ 












.Mental Cloud 
















-r 


Persistent 1 leadache 








# 












Heart Lesions <i_ 


*='!*H 






m m m 


m 












1 >ropsy 








m 










34 














Kidney Lesions. Brights 


















3S 






I.n er or ( '..ill Lesions 






■ 








31 
38 

3» 








Appendicitis 


















# 




Stomach pain or Ulcer 






# # 








4 1 

42 

* 3 
44 

49 
48 
4T 
48 
4» 
SO 
SI 
S2 
S3 








Rye, Ear, Skin. Shingles 
















* * 










Pneumonia 




g& 














Anemia 
















< .oiler 
















- 


Lassitude, Chilliness 




* 


















Hardening of Arteries 
















Stroke 




























Age if Living 
























Age at Death 




AJ,T3I 


so 


SB 
ST 
SB 

31 








Flu with Complications 




















Flu without Complications 


































B 1 
S3 

S3 
84 
• J 

ss 

ST 
BB 

BO 
TO 








"incVxPcL -Ffidi .sliokt 














Q-fiSOTpTi nYl 














■ ■ 


Extensive Tooth Decay 










' 






Abscessed Teeth 






















Loosening Teeth 












; 




Key for -t- Had lesion 

CHAftT -Jf-FRCOUENTIT 


#V£BT SEVeotir 3>fe OPIRATION 

+ J Probably © Fatal Attack 


71 
T2 












/ CARIES LOKII CONI1SXG 

\\ # -# ^ * 


-1.. IH.. 

# 
RA.HG. 


MM. 

ki .: i . 


COMP. 


PART. 


KICK 


NONE 


1 VCTOR OH SAFETY 
V.HG. HIGH FAIR LOW \ 


- ' PYRRH ••11 N HK1 IXG 


SI'SC. 

i i.i i. 


1 NUT. 


iOHi. 


kllST. 


SC. NO 


* 



Figure 265. Resistance and susceptibility history chart of Cask No. 385. Note nine 
•cases of heart disease in family. with four deaths. 



50 DENTALINFEC riONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

patient presented, after a long bedridden illness, and her mother, 
the patient's grandmother, died of heart involvement. Both this 
patient's mother and mother's mother had also suffered severely 
from rheumatism. The patient's father and a brother had each 
suffered severely from a type of nervous indigestion. 

We find, then, an illustration of what we have found so many 
times in these studies: that when an hereditary susceptibility 
con is in from both sides of the ancestry, the offspring tend to 
break in these same tissues; and further, that while they break 
in the same tissues, the break tends to come much earlier than in 
the ancestry. We have, then, a family of six children, the oldest 
of whom was twenty-five, all suffering from acute rheumatism 
either at this time or had in previous time, and three of whom 
w ere suffering from acute heart or had in the past. This clearly 
establishes that this patient's best is far too low to withstand the 
normal overloads of life, if we would assume some dental infection 
as being a normal overload for a normal individual. 

But there are ether overloads, as we have shown so frequently, 
which combine with dental infection overloads greatly to aggra- 
vate them. Young people with invalid parents to sustain, having 
the care not only of their own maintenance but of the maintenance 
of the invalids, are very likely to have a capacity physical load 
which may easily become more than a load ; or, in other words, a 
distinct overload. We must consider then that notwithstanding 
every overload that we may take from this patient, including the 
dental involvements, she should be expected to have to maintain 
a struggle throughout life to retain even comfortable health. 

A physical examination of the patient revealed a mitral mur- 
mur and an accentuated pulse rate, so typical of an irritated and 
weakened heart. What should the dental diagnosis be in this 
case? And before making it, remember that as she appeared she 
brought all the vanity of an ignorant girl. She did not want to lose 
her own front teeth. She was afraid to lose any molars for fear 
her face would settle in. She did not wish to wear a plate for fear 
it would affect her expression and speech. She looked just like. 
so far as the ordinary dental observer would have appreciated, all 
thi' rest of the girls of her age; and this background that we have 
worked out was not any information that she brought to us, but 
w as information that we had to go after. I stress this because we 
tend to justify our diagnoses on the presumption that we have a 
knowledge <>i the patient, adequate for making the important 
decisions. My fear is that this is seldom true. 

The incidence of heart disease as a cause of death increases 



CHAP. I. IX APPLICATION OF EXPERIMENTAL IX) CLINICA1 ..1 

wry rapidly and constantly with age. This has been most 
strikingly brought out by Dr. Louis I. Dublin, 1 statistician lor tin 
Metropolitan Life Insurance Company, who, in a paper read 
before the Boston Association of Cardiac Clinics, Boston, May 18. 
1922 (published in The Nation's Health for August, 1922), 
stated as follows: 

"The first point that comes to view from an examination of the 
tables and of the graphic illustration is that the incidence of 
heart disease as a cause of death increases consistently with age. 
At the age period 35 to 44 when persons should be at the height 
of their productivity, one white person dies from heart disease in 
every thousand living and two colored persons out of each thou- 
sand. At the age period 65 to 74, the number of deaths from 
heart disease has increased to about 15 in each one thousand 
living, or to put the facts in another way, deaths from heart 
disease constitute 9.3 per cent of all deaths at ages 35 to 44, but, 
at the older period, 65 to 74, they are responsible for 21.9 per 
cent of the deaths. There is no exception to this rule. The rates 
are also very much higher for colored persons than for whites. 
The sex ratios of heart disease mortality are also rather interest- 
ing. The rates are usually higher for females than for males up 
to age 30. From that age onward, the rates for males are higher, 
the difference becoming regularly greater with advancing years." 

These studies of the Metropolitan Life Insurance Company 
are particularly important in connection with the data that we 
have accumulated from our clinical practice and research. An 
analysis of the data shown in Chapter No. 4, Systemic Structural 
Changes, reveals the important fact that 100 per cent of the 
individuals suffering from heart involvement have extensive 
caries. This is also shown in Figure 83 of Chapter 9, The Rela- 
tion of Dental Caries to Systemic Disturbance. If, then, the 
percentage of death from heart involvement increases very 
rapidly after the age of forty-five, is it simply a coincidence that 
these patients, in nearly 100 per cent of cases, have extensive 
caries and consequent apical involvement? It is too early to 
undertake to publish extended statistical data on this point, but 
the evidence at hand demonstrates that the incidence of death 
from heart involvements is very greatly reduced for the same age 
periods among the individuals with a history of heart involvement 
who have had their dental infections removed, as compared with 
those with that history who have not had their dental infections 
removed. 

In other chapters, we have discussed and interpreted the path- 

1 See bibliography. 



52 DENTAL INFECTIONS* DEGENERATIVE DISEASES c LINK AI. VOL. II 

ology about the infected tooth in comparison with the same con- 
dition in other patients and its significance in relation to the 
systemic defense. We have shown that the changes in the sup- 
porting structures about a root apex are primarily records of the 
tractions of that individual patient to that type and quantity of 
infection, and that that reaction is a protective one in that it is 
largely Nature's effort to maintain a quarantine about the tooth, 
or is the effect on the one hand with a patient with high defense 
and relative safety, or a record of the reactions of the local irri- 
tants upon the supporting structures which are not adequately 
contributing in an adequate defense for the patient. 

Applying that information to this patient's case, we find that 
the total quantity of infection involved in the lateral tooth with 
the putrescent pulp is sufficient in normal patients to develop a 
very acute inflammatory reaction about the root apex with the 
production of soreness, and therefore a tender tooth, and usually 
with a fistula. This patient's lateral tooth with a non-vital pulp 
not only has no fistula, but has no extensive area of absorption, 
has no history of soreness. What I wish to stress is that the very 
absence of these symptoms is a bad sign and not a good sign, and 
argue for the extraction of this tooth and not for its retention, 
since it has as much infection as would be available in a putrescent 
pulp. Our diagnosis, therefore, was that her immediate safety 
demanded the removal of all dental infection possible, which 
included not only teeth with putrescent pulps and chronic apical 
lesions, but these with deep caries involving, as did her molars. 
the major portions of the crowns of the teeth even though the 
pulps were vital. And these molar teeth were condemned not 
only because of the difficulty of being certain regarding the 
amount of infection in their pulps and the difficulty of determining 
how completely Nature might eliminate that infection, but be- 
cause the probability of these pulps' dying under any restorations 
that might be put upon them is so great and the effect of such an 
outcome would be so serious that we are gambling the patient's 
health and very life against the problem of a questionable service 
of these teeth. The odds in such a case are far too great against 
the retention of the tooth. Even a toothless patient with a heart 
that will work, even with a murmur, is infinitely better than a 
quantity of gold crowns or any other type of more approved 
dental restorations, and they incapacitating the patient. That 
heart can maintain life only under the most favorable possible con- 
ditions; and the result has abundantly justified our decision. 
In a lew weeks' time, this girl was back to work. In the five 



CHAP. I. IX APPLICATION OF EXPERIMENTAL TO CLINK u 53 

years that have intervened she has not lost a day because of her 
rheumatism or heart involvement. She gained over twenty 

pounds in a lew months' time, and all the money in the world 
could not compensate her for the mistake that would have been 
made by a less intelligent program. 

It is important to note that the very thing that we have indicated 
would be likely to happen, had already happened with this 
patient in question. Her brothers and sisters will tend to have 
the same type of defense as an ancestral legacy, and one brother 
and two sisters have also broken in the last five years since this 
patient presented, and with quite similar symptoms and marked 
benefit. However, we must, in these cases, remember that the 
prognosis must always be influenced by the nature and degree of 
this inherited susceptibility. These patients should plan their 
lives not only to prevent all overloads that are within reach of 
their planning; but so far as their dental infections are concerned, 
they are largely at the mercy of the dentist in whose hands they 
may either choose or be compelled by circumstance to place their 
lot. This, then, is fundamentally a responsibility of the dental 
profession; and while the members of that profession may be 
largely responsible for the carrying out of the teachings, the ulti- 
mate responsibility must go back to the dental colleges which 
furnish the ideals and the methods for their being carried out. 

And again we stress how many of the one in ten funerals that 
go by your window because a heart has given out, have we as a 
dental profession either helped to produce or failed to prevent. 
As I dictate this paragraph, my memory goes back to patient 
after patient whose life has gone out prematurely at forty, fifty, 
and sixty years of age, from heart involvement and other compli- 
cations, but particularly with heart, and in w ? hose mouths there 
were teeth which, according to my information at that time 
i which was the teaching of dental practice) had not sufficient 
evidence of pathology to condemn. As I would now interpret 
those teeth, what I mistook to be insufficient evidence of path- 
ology, was an inadequate local reaction; and the lack of rarefac- 
tion or evidence of condensation of bone were really evidences of 
that poor defense ; and I have no doubt that many of those pa- 
tients, some of whom had come to be very dear friends, might 
have lived for years had I known to put into practice what I am 
teaching in this book. While ignorance may be bliss, there is 
perhaps no pain or grief like that expressed in the following words : 
"Of all sad words of tongue or pen, 
The saddest are these: 'It might have been!' ' 



CHAPTER LX 
CIRCULATORY SYSTEM. 

DISCUSSION. 

In this group we will study the various lesions of the circulatory 
system which may be influenced or produced by dental infections. 
These will include endocarditis, myocarditis, pericarditis, heart 
block, aortitis, angina pectoris, phlebitis, arteriosclerosis, hypo- 
tension and hypertension, anemia, leucopenia, leucocytosis, 
lymphopenia, lymphocytosis, bacteremia, and glycemia. In the 
past the emphasis in our thinking has been placed upon heart 
valve lesions probably, both because of their severity and fre- 
quency and also the fact that there has been very little known of 
other lesions', of the circulatory system, being produced or aggra- 
vated by dental infections. Since one in ten, and probably a 
little more, according to the data in both England and the United 
States, of the deaths of all ages reported from month to month, 
are caused by heart involvement.it becomes immediately apparent 
what a great responsibility falls upon the dental profession. If it 
fail to remove the causes of any cf these heart involvements, and 
more particularly if it produce conditions which tend to develop 
them, if, as many believe, approximately 90 per cent of heart 
involvements are the result of streptococcal invasion, we see an 
immediate suspicion thrown upon the dental source. This 
suspicion is increased by the finding that practically all dental 
infections, apical or gingival, contain streptococci, and in the for- 
mer, particularly, of types that may readily develop elective locali- 
zation for heart tissues. The results of these researches throw a 
very important new meaning and importance on this whole 
problem for it has been found that in a group of 681 families 
there were more cases of heart involvement in 100 families than 
in the other 581, and in only 51 single cases were patients found 
to have developed a heart lesion where no other member .of the 
family was recorded to have developed the same. In other words, 
in 92 : 2 per cent of patients in whom heart lesions were found, at 
least some other members of that family were recorded to have 
had a heart lesion. 

54 



CHAP. LX- CIRCULATORY SYSTEM ENDOCARDITIS 

Since this presentation is a report of researches and not a 
treatise on pathology, it is not within its scope to do more than 
outline the main features involved. Since, as shown, such a large 
percentage, namely from 10 to 11 per cent, of the deaths of all 
ages which occur in our civilized communities of today is, accord- 
ing to statistics, from some form of heart failure, it becomes one 
of the most important problems in the health of the community 
to prevent, in so far as possible, heart lesions. While authorities 
differ as to the percentage of the various types of infection found 
in heart lesions, it is quite generally conceded that organisms of 
the streptococcal group produce a very large proportion of these 
involvements, some placing them as high as 95 per cent. It cer- 
tainly is high, whatever the exact percentage may be in a given 
community. It is not within the range of this study, or at least 
we have not included it as such, to make estimations or deter- 
minations of the incidence of dental infections and heart lesions of 
focal origin. I am, however, convinced that there are very many 
such cases and many in which dental infection may not have been 
the first source of focal entrance. Indeed, many of our histories 
suggest that tonsil involvements in children have been followed 
by some heart disturbance from which the patients have appar- 
ently quite completely recovered. Since, however, they had an 
inherited susceptibility, or lowered defense, for that tissue, and 
since one streptococcal infection tends to predispose toward 
another, the presence of a dental infection has tended to re- 
establish acute involvements of the heart and circulatory tissues. 

ENDOCARDITIS. 

Endocarditis, with its involvements of the heart valves and 
lining membranes of the heart, constitutes one of the most serious 
affections of mankind. For years it has been recognized that it 
frequently appeared as a sequel to tonsilitis. It now seems very 
necessary to study carefully its possible relationship to dental 
infections. We have already discussed, in Chapter 17. the case 
of a boy, fifteen years of age, w r ho was brought in by one of the 
district nurses because he had rheumatism. We very quickly 
discovered that he had a serious heart involvement with much 
enlargement and rotation outward of the apex. The history of 
his case showed that about four weeks previously he was afflicted 
with an acute attack of pulpitis or tooth-ache at school. This 
seemed definitely located in the mandible on the left side in the 
first permanent molar. About a week after his acute tooth-ache, 







FlGURl 266 \i i ii ENDOCARDITIS IN TWO RABBITS FROM 1 a CULTURE PROM DECIDUOUS TEETH SHOWN, FROM Hill It 
WITH I- Mi t. VRDITIS. 



CHAP. LX CIRCULATORY SYSTEM ENDOCARDITIS 57 

he developed acute rheumatism and myositis so severe that he 
could not get up from his seat in school, which necessitated his 
being carried home. The acute condition subsided in about a 
week and he returned to school. The teacher reported that he 
was very lazy. The suspected tooth was extracted; but before 
doing so, careful examination was made to determine the condi- 
tion of the pulp. The tooth had very extensive caries in the 
crown, which, however, did not expose the pulp, though it had 
infected it. The tooth responded very sharply to changes of 
temperature and was sensitive to instrumentation within the 
cavity. On the removal of the tooth, the pulp was opened after 
sterilization of the dentin, cultures were taken from the pulp, 
which grew out pure streptococci, and this was inoculated into 
thirty rabbits. Ninety-three per cent developed acute endo- 
carditis and 100 per cent acute rheumatism. In the chapter on 
tissue affinity qualities, characteristics of organisms, we have 
referred to the fact that subsequent inoculation of a second 
grcup of rabbits with this strain, after it had grown on artificial 
rredia for seventeen days, showed its elective localization very 
greatly changed. The percentage of hearts involved had fallen 
to 10 per cent. Incidentally, the boy died in about seven months 
from acute endocarditis. 

In cases of acute endocarditis, the elective localization quality 
of the organisms seems particularly marked. In Figure 266 are 
shown two rabbits which were inoculated with the culture taken 
from the shown deciduous teeth, two of which had infected 
pulps, of a little girl nine years of age. (Case No. 1058.) She had 
been in bed five of these nine years. We do not know the nature 
and history of the early attacks or the probable source. The 
culture taken from the pulp chambers of the extracted deciduous 
teeth was injected into the ear veins of three rabbits and all de- 
veloped acute endocarditis and myocarditis. The one shown to 
the left had the greatest enlargement of heart that we have ever 
seen in a rabbit on posting, and that shown to the right died on 
the thirteenth day from the acute endocarditis. The rabbit 
shown to the right also had rheumatism, with marked enlarge- 
ment of the axillary lymphatics, as shown. These rabbits were 
inoculated with the washed culture of the organisms taken from 
the teeth. 

It is very significant that in children suffering from endocardi- 
tis, rheumatism, or chorea, there is a marked tendency to delayed 
absorption of the roots of the deciduous teeth and delay in their 



58 Di.M \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 







« 



Figi M 267. Fatai endck tRDms in a rabbit inocui \IT 1> « mi ^BOUT ONE-MILLIONTH of a gram 
I IF I IRC tNISMS IK' IM nil u ISHINGS OF CRUSHED 11 1- 111 FROM \ PATIENT W I Til ENDOC ARDITIS. HEART 
SHOWN IN A; nil III ill l\ I. \\I> I >.]'.. \\ AORTIC IRCH INVOLVEMENT FROM ANOTHER RABBIT INOCU- 
I \llh FROM rWO OTHER I! 1 III FROM --AMI PATIENT, SHOWN 1\ E \\P F. 



i 



CHAP. I.X -CIRCULATORY SYSTEM ENDOCARDITIS 

exfoliation. This seems definitely to be related to depressed 
ionie calcium of the blood and disturbed calcium metabolism, 

which not only produce calcium hunger, but the very absence 
of the calcium ions directly disturbs, as I have shown, the meta- 
bolic processes and cell activities of practically all tissues and 
particularly those relating to morphological changes. This is an 
exceedingly important, and often serious, problem, for the very 
individuals who should be free from focal infection of deciduous 
teeth, are compelled to retain that infection because of disturbed 
metabolism relating to their exfoliation. I have no doubt that 
many a child has died from heart involvement who would have 
recovered had the infected deciduous teeth been removed. In 
these cases these infected deciduous teeth produced practically 
no discomfort to the individual; and we have been very often 
misled in presuming that because they were comfortable they 
were safe. Only those who have paid the price can know the 
seriousness of this mistake. I, myself, am one who was mistaken 
about the safety of my boy's deciduous teeth. Though they were 
roentgenographically in good condition, several of them having 
been treated and root-filled, they proved on extraction to be 
seriously infected and were being carried by an individual who 
had a heart involvement growing out of one severe attack of 
tonsilitis followed by acute rheumatism. 

It is not necessary, however, that the quantity of organisms be 
large in strains having marked elective localization, which qual- 
ity we have found only in acute processes. The heart shown in 
Figure 267-A is that of a rabbit which died in two weeks after 
being inoculated with the unfiltered washing from three teeth, two 
of which were root-filled, shown in Figure 267 in C and D. This 
rabbit developed both acute endocarditis and aortitis. We appre- 
ciate the impossibility of proving that these hearts were normal, 
and since aortic arch lesions have been reported in apparently 
normal rabbits, it makes an uncertainty as to whether this aortic 
arch lesion may not have been present previously, if not in its 
present aggravated form, in some form perhaps very much less 
severe. The fact, however, that the rabbit died with endocarditis 
from this small amount of infection is very important. The 
actual weight of the bacteria injected would probably be in the 
order of about a hundred millionth of one gram. Another rabbit 
inoculated with a culture from two other teeth from this patient, 
(Case No. 1113) shown in Figure 267 in E and F, developed aortic 



CHAP. LX CIRCULATORY SYSTEM ENDOCARDITIS (>1 

ulcer with marked degenerative changes in the muscular coats 
and intima. The following is the pathological finding in this 
heart tissue : 

"Inverted Ocular shows three small semicircular pieces of tissue 
from blood vessel, where the intima and media coats are well 
stained with a red-pinkish color; the adventitia with a light pink. 
In all the three sections there is an elevation at the center of the 
intima and media. 

"Low Power. The section represents blood vessel wall i aorta). 
The intima is not well shewn; only here and there can be seen 
remnants of the intimal endothelial lining. The media at the 
central part of the section shows distinct changes, namely for 
about 2 to 3 mm. it is swollen, and separated into two parts, 
which might be due to mechanical causes. The swollen portion 
shows many cells in degenerative processes; vacuoles can be seen 
surrounding the nuclei. There are practically no changes in the 
layer of adventitia surrounding that particular place of the media. 

"High Power. The media at the central part shows fatty 
degeneration, the cell being filled up with small vacuoles which 
are pushing away the nuclei. The nuclei are taking good stain. 
There are no evidences of any cellular infiltration. This condi- 
tion is found only at the central part of the section. The rest is 
in good condition. 

"Diagnosis. — Atheromatous degeneration of the aortic arch." 

In patients with a definitely developed susceptibility to strep- 
tococcal infection, expressing itself in heart irritation, there is a 
marked tendency to recurrence, particularly with the redevelop- 
ment of the focus as a source from which the infection may be 
developed. Figure 268 shows such a case. (Case No. 581.) About 
two years ago, she was brought in in a condition of extreme pros- 
tration from endocarditis and myocarditis, and was carried to 
our ward and operated upon in bed with the greatest possible care 
and consideration for her weakness. Her improvement was very 
rapid and pronounced. In a couple of weeks she was home about 
her house, and in six weeks her physician was permitting her to 
take light responsibilities about the home, and even walking up 
and down stairs. The heart enlargement had decreased and its 
irritability subsided. About two years later she suffered a recur- 
rence of her endocarditis, with weakness and prostration and very 
marked dyspnea, which compelled her to gasp for breath about 
every half minute. Careful study of her mouth, roentgenograph! - 
cally, did not reveal a source of dental infection. However, the use of 



62 DENTAL INFECTIONS*! DEGENERATIVE DISEASES ( LINICAL VOL. II 

the electrical and thermal tests for vitality revealed the presence 
of a non-vital pulp in the central incisor shown in the insert A. 
Note the absence of roentgenographic evidence. This tooth was 
extracted and its pulp cultured. Figures B and C show the 
hearts of two rabbits inoculated with this strain, both of which 
show marked endocarditis. In B, there are shown two large 
masses of coagulated exudate found within the pericardium. 
This patient's improvement was so marked that again in a few- 
weeks' time she was at home doing most of her household duties, 
even walking up stairs. 

BACTEREMIA. 

Bacteremias are coming to be recognized as of frequent occur- 
rence. Their symptoms may be very definite from the early 
stages, having much the appearance of an approaching febrile 
disturbance, the severity increasing progressively or intermit- 
tently, with or without evidences of heart involvement. The 
diagnosis seems to be most easily established by blood culture. 
The attacks may, however, come on violently and seem to be 
related to tonsilitis, surgical operation, an abscessed tooth, or 
some such acute process. It is, of course, always difficult, if not 
impossible, to tell with definiteness the source of the infection. 
The most significant thing is that they occur in individuals with 
an abnormally low defense for streptococcal infection, for the 
organism involved is very frequently the streptococcus. A close 
study of the history, morphology of the organisms, the biological 
characteristics of the strain, as established by fermentations, etc., 
together with the identification of the strain in some focus, will 
be an important procedure in determining the etiology of the dis- 
turbance. Such a case is shown in the following: 

Case No. 926. Figure 269 shows in B an area ol radiolucency to 
the Roentgen-ray, about the apex of the lower left second molar. 
This tooth was extracted, and attached at its apex was a very 
large granuloma, shown with the tooth in A. The patient was 
suffering at the time from rheumatism and a mild fever. Her 
symptoms became rapidly worse after the extraction of the tooth 
and curettement of the socket. She was kept in bed in our pri- 
vate ward, and blood cultures showed organisms in abundance in 
the blood stream. The lymphatics showed marked involvement, 
and cellulitis developed, involving the neck. K. F, and G show- 
organisms grown out by culture from the aspirated blood from the 




Figure 269. Streptococcal bacteremia: A, a degenerating granuloma of unusually large size, from the 

SECOND MOLAR SHOWN IN B. E. F, AND G SHOW ORGANISMS GROWN FROM THE BLOOD TAKEN FROM THE MEDIAN BASILIC VEIN 
ON THREE DIFFERENT OCCASIONS. C, ORGANISMS IN THE BLOOD ASPIRATED FROM THE NECK; AND D, ORGANISMS IN A PHA- 
GOCYTIC LEUCOCYTE. 

median basilic vein on three different occasions. C shows or- 
ganisms in the blood aspirated from the neck tissue; and D, or- 
ganisms in a phagocyting leucocyte. The culture grown from 
this tooth was inoculated into rabbits. Figure 270 shows one which 
developed acute rheumatism of the wrist joints and fore paws, 
which later developed into a typical deforming arthritis. The 
legs were bowed sideways and the rabbit walked on the sides of 
its fore feet, and for a long period was unable to hop, stubbing 
along with great difficulty like an old man nearly crippled from 
deforming arthritis. This rabbit lived, in apparently fair health, 
for twenty-five and one-half months after this inoculation of a 
single dose of the culture from this tooth ( the amount of the dose 
being 1 cc. of a 24-hour growth of dextrose-ascites culture) and 
died finally of an acute or chronic peritonitis which, at post- 
mortem, within a few minutes after his death, showed in culture 
a streptococcus growing in diploid forms similar to that injected, 
in the multiple adhesions of the viscera and peritoneum. It is of 
interest that we never have found this type of infection or of le- 

63 



64 IM-.Vl \i.im Ix riONS& DEGENERATIVE DISEASES CLINICAL VOL.11 




FIgure 270. Old Patrick. This kabbit lived por twenty-five and one-half month-- after one 
inoculation from culture of tooth, figure 269. he developed first acute rheumatism, then 
deforming arthritis, had bowed legs, and walked on tiik sides of iii- feet. 

sion in the animals dying spontaneously that have not been pre- 
viously inoculated with streptococcal strains. Figure 270 shows 
the roentgenograms of the bones of the forelegs. Note the de- 
formity and enlargements. Figure 271 shows the rabbit as he was 
nineteen months after the inoculation. While he had grown 
large and heavy, he tended to be adipose and decrepit. As shown 
by the roentgenograms of different periods, there was a slow 
tendency to reduction of the arthritic deposits but never a restora- 
tion of function of the joints. 



CHAP. LX CIRCULATORY SYSTEM BACTEREMIA 



65 






Figure 271. Other views of Old Patrick with his deforming arthritis. 
permanent deformity. he grew very large and heavy. 



Notwithstanding his 



Individuals with a very marked streptococcal susceptibility 
frequently have characteristic symptoms which are very sugges- 
tive. Their normal temperature is a subnormal of from one to 
four degrees. They may have a temperature which goes above 
this subnormal two or three, or even five or six degrees, usually a 
little above or a little below the true normal. This must be kept 
in mind; otherwise, it would not be recognized as a febrile dis- 
turbance. Their disturbances, however, are quite different from 
individuals with localizations without bacteremia. 

Case No. 987. — Figures 272 and 273 show several views of 
rabbits inoculated with a culture from another such case. This 
patient's eyes were, frequently, both reddened. Their symp- 
toms were very severe. During a period of about six years she has 
had severe recurring attacks; has never been entirely free for 
more than a short period of time, if at all; and her case repre- 
sents a type for which the prognosis must always be extremely 
guarded. The symptoms have tended to develop in a somewhat 
definite order, one of the earliest of which was the eye involve- 
ment which would go through progressive stages of severity and 
become very painful and sensitive to light, after which, there 
would be considerable dimness of vision, so severe on several 
occasions that for days or weeks it would be difficult for her to 
make her way alone across the street. The use of an autog- 



ii<; DENl VL INFECTIONS & DEGENERATIVE DISEASES CLINICAL V 



OL II 







C JsSSf. 2?2 M '""'" LESIONS PRODUCED IN RABBITS FROM A CASE OF RECURRING STREPTOOOCCA1 



BACTEREMIA. 



^ 



CHAP. LX CIRCULATORY SYSTEM BACTEREMIA 67 




Figure 273. Others of the multiple lesions produced by the dental cultures from Case 987 with 
streptococcal bacteremia. 



68 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

enous vaccine administered at the time of the onset of one of 
these attacks or the earliest symptoms of one of these cycles 
tended to abort the development of the cycle. The eyes would 
clear up without the customary pain, congestion, etc., and would 
not be followed by the acute rheumatism, though occasionally 
with mild symptoms of it. 



I-'H. I RE 274. SOUIH EOF CULT! RE TOR 
I\' i i I \l IONS I ROM C VS1 



t 



* 



L 



The culture from the tooth, shown in Figure 274, when inoc- 
ulated into rabbits, produced expressions in many and varied 
tissues. A and C of Figure 212 show the progressive involve- 
ment of a rabbit's eye; E, acute rheumatism; D and F, views, 
on different days, of the left hind leg of a rabbit showing a very 
marked edema which subsided without joint change-. A. B, 
and C of Figure 273 show extensive rheumatic involvements 
with enlargement of the axillary lymphatic glands. Figure 
273-D shows hemorrhagic infection of the pulp, so marked that 
it shows readily through the tooth in situ. Figure 272-B shows 
an acutely nephritic kidney. Cultures from this woman's tooth, 
blocd stream on several occasions, and eye at the time of the 
acute inflammatory processes of it. gave the same organism and 
same type. 

It is important to note that this patient's symptoms were very 
general and diffuse, which tends to be true of the systemic expi 
sions of bacteremias. She had involvements of her eyes, acute 
rheumatism, heart irritations, frequent febrile disturbance, and 
edema, any or all of which symptoms would tend to become 
rapidly worse, but usually in succession. Cultures inoculated into 
animals from the dental infection, the blood stream, and the 
eyes, similarly tended to produce very diffuse disturbances. Just 
as this patient's wrists would be swollen in t went y-four hours and 
very painful with edema, which condition would subside quite 
as rapidly, just so the animals tended to be affected. The hind 
leg, shown in two views of twenty-four hours apart, illustrates the 
rapid reduction of the edema. Within twenty-four hours after 
inoculation this rabbit was carrying this hind leg. with the edema 
and swelling of its foot. The swelling disappeared. Another in- 



CHAP. LX CIRCULATORY SYSTEM RAYNAUD'S DISEASE 69 

oculation was given and again in twenty-four hours it was carry- 
ing the foot. It will be noted that the infection in these rabbits is 
more generalized than is usually found, as I have shown in 
ether chapters. 

It would seem probable that this streptococcal invasion of the 
blood stream, in so abundant a form as we have found it, would 
make possible the securing of this organism in almost any tissue 
of the body during these periods; and if any tissue were capable 
of becoming, because of degeneration, a pabulum for the growth 
of the organisms, it would readily be inoculated from the blood 
stream; and if such a patient should develop a non-vital pulp, 
it would seem very certain that it would become immediately in- 
fected with this strain. In this sense, it may probably be said 
that, the systemic infection, or bacteremia, has caused the dental 
infection rather than that, the dental infection has caused the 
bacteremia. It should be kept in mind, however, that all Nature's 
normal tissues lend themselves to Nature's mechanisms of repair 
and defense so readily that in normal tissue Nature is able, gen- 
erally, completely to eliminate the systemic infection. If, how- 
ever, any tissues such as dentin and pulp tissue have become non- 
vital, Nature has no mechanism again to place that tissue in a 
sterile condition, and it immediately becomes a focus, and per- 
manently so, so far as Nature is concerned, and, notwithstanding 
the violent opposition of many members of our dental profession, 
such infected tooth structure is, in effect, if not literally, an in- 
fected sequestrum. 

RAYNAUD'S DISEASE. 

Raynaud's disease is a vasomotor neurosis which is supposed 
to affect chiefly children and young adults, but which has been 
present in a number of cases studied in this clinic. Its etiology is 
very obscure. In the severe cases it is marked by capillary con- 
gestion and livid swelling which may eventually result in gan- 
grene. It not infrequently happens that individuals afflicted with 
this disease will have one after another of the fingers or toes ampu- 
tated as the disease progresses. The affection is very little 
affected by local or systemic treatments which are designed to 
affect the capillary circulation. One of the cases of particular 
interest in this connection is as follows : 

The patient, male, about fifty, had a severe affection of the 
toes of one foot, one of which had been amputated about three 
years previously. A second toe became acutely involved and pro- 
ceeded to a gangrenous necrosis and required an amputation about 



one year before. When he presented to me, a third toe was seri- 
ously affected and there seemed every indication that it would 
suffer the same late as the other two. He had several dental 
infections which were removed, which resulted in a very marked 
improvement in his Raynaud's disease which did not manifest 
itself again for a year, after which time I lost connection with him 
and do not know his later history. It seems very probable that 
this disturbance was largely a sensitization process in its early 
stages. 




70 



CHAP. I.X CIRCULATORY SYSTEM— ANGINA PECTORIS 71 

ANGINA PECTORIS. 

It is uncertain to what extent dental infections contribute to 
angina pectoris. We have, however, records of several cases in 
which the disturbance disappeared promptly and for sufficient 
periods of time to warrant the belief that the relief was produced 
by the removal of the dental infection. To illustrate: 

Case No. 1241. — A patient presented with obscure disturbance 
in the vicinity of the chest and heart. Sometimes he could walk 
many miles without any discomfort, and on other occasions 
would be almost prostrated from pain and exhaustion. The 
dental examination revealed conditions that were considered 
border-line. They would readily be interpreted, as shown in 
Figure 275, as having slight pathology. In order to strengthen 
our basis for our diagnosis as greatly as possible, he was carefully 
examined by the internist of my staff, and we decided to send 
him to a heart specialist for confirmation or correction of our 
diagnosis. That report strongly strengthened the basis of our 
suspicion, and these border-line teeth were extracted, with the 
result that his angina symptoms entirely disappeared and have 
not returned, even for a moment, for nine months. This was 
particularly important, as will be seen by referring to the roent- 
genograms in Figure 275. There is so little evidence of dental 
pathology. These teeth, when cultured, showed definite internal 
infection with streptococci which, when inoculated into rabbits, 
produced both heart and kidney lesions. 

One of the teeth of his case was placed beneath the skin of a 
rabbit, after having covered with celloidin its entire surface ex- 
cept the root apex. (Note: Our previous experiments have 
shown that celloidin is but slightly irritating when planted in the 
tissue of rabbits.) The rabbit proceeded to build an encapsula- 
tion about the tooth. A photograph of the encapsulated tooth is 
shown in Figure 276-B. A local abscess, however, developed 
and it died in twelve days, having lost 25 per cent. This rabbit's 
heart appeared congested on posting. On the anterior surface 
there were two triangular whitish patches about three-fourths of 
an inch in extension. On cutting transversely over the same, 
the whiteness extended into the muscle tissue for about one-half 
millimeter. A photograph of the heart is shown in C, and a 
section of the heart muscle showing the fatty degeneration is 
shown in D. The kidneys of the rabbit showed parenchymatous 
nephritis and local hemorrhages, a section of which is shown 
in A. This patient died suddenly about one year later. 



72 DENTA1 INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 



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lu.l RE 276. Effect OF IMPLANTING A TOOTH from Case L241 BENEATH THE SKIN OF A RABBIT. B| photograph of the 
i \c u»si i \ii'i> room C, A photograph of this rabbit's heart. D, section OF THE HEART Ml SCLE SHOWING FATTY 

M CENER \lle\. A, A SEC TION OF Till- KIDNEY, PARENCHYMATOUS NEPHRITIS. 



CHAP. I.X CIRCULATORY SYSTEM— HEART BLOCK HEMOPHILIA 73 

HEART BLOCK. 

Case No. 900. In the chapter on dental cysts, I discuss a case 
of a very extensive invasion with absorption of root apices. This 
patient seventy-six years of age, was brought to us suffering from 
a very severe central nervous system disturbance and extreme 
hypotension, which varied sometimes quite rapidly. He had, 
on several occasions, given evidence of symptoms which his 
physician had diagnosed as heart-block. After the surgical 
treatment of his cyst, this symptom entirely disappeared so that 
he could walk for miles at seventy-six years of age as rapidly and 
comfortably as most men of thirty; and after two years, he is 
still free from those symptoms which had so nearly taken his life 
on several occasions. When brought by the physician, he was 
considered to be in such a critical condition that we were advised 
to be extremely careful or he might go out at any moment. The 
hypotension was quite completely relieved and it, also, for two 
years has remained nearly normal.V Roentgenograms of his case 
are shown in a figure of Chapter 69. 

HEMOPHILIA. 

Few, if any, of the effects of dental infection are so marked as 
the chemical changes in the blood, conspicuous of which are the 
anemias and hemophilia. A typical case of the latter is as 
follows : 

Case No. 1024. — A man of thirty-eight years of age was re- 
ferred by a physician with the following history: For three 
months there had been almost constant seepage of blood from 
the mucous membranes of the mouth, chiefly about the necks of 
teeth, with occasional bleeding of the nose and throat. He had 
been very near death on several occasions. A few weeks prior to 
his being referred, he had had two blood transfusions which gave 
exceedingly little and temporary relief. The socket of a tooth 
extracted three months previously was still bleeding. The roent- 
genograms revealed the condition shown in Figure 277. Careful 
examination showed that the hemorrhage was greatest around 
the non- vital teeth. On the presumption that these teeth were 
furnishing a toxic substance which was contributing to this con- 
dition, we deemed it wise to remove one of these for study and ob- 
servation of the effect, notwithstanding the great danger and 
difficulty attending the control of the hemorrhage following the 
extraction. Extreme care was taken and immediate packing of 
the socket and retaining of pressure to prevent hemorrhage was 



71 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 





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76 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINIC \I. VOL.1] 




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Figure 279. Spontaneous hemorrhages i\ rabbit's kidney and thick Case 1024. 

M \\Y R USIUTs DEVE1 OPED DEI Wi I> ( I OTTING OF BLOOD FROM Tills UT 11 Kl -. PATIENT GRE \T1 V 
IMPROVED. 



CHAP. I.X CIRCULATORY SYSTEM HEMOPHILIA 77 

done. Notwithstanding this precaution and the close attention of 

a skilled nurse, a few ounces of blood were lost in a lew hours. 
The tooth was used to make a vaccine from its culture; the or- 
ganisms grown from it were also used for animal inoculation. 
These lengthened the clotting time of the blood of rabbits, which 
had been found to be normal at a half minute to a minute, to three 
and four, and in extreme cases to six and ten minutes, which is 
very unusual for rabbits, it being extremely rare that severe spon- 
taneous hemorrhages occur. In the last thousand rabbits in- 
oculated in the last two years, only a few rabbits have died from 
spontaneous hemorrhage, one of which is shown in Figures 278 and 
279, which was inoculated with the culture from the tooth of this 
case. It died in twenty hours from extensive hemorrhages into 
the thighs, legs, viscera, kidneys, etc., and there was so little blood 
left in the circulatory system that it was impossible even to get 
a small amount for blood chemistry, which is frequently made 
in such conditions, by aspirating blood from the heart and larger 
bleed vessels. This rabbit was posted immediately upon its 
death, which death process was being watched, and there was 
not time for any clotting of the blood within the vessels, which 
process was very slow in this rabbit. 

With the extraction of this tooth and the use of the vaccine 
made from it, this patient's condition very rapidly and markedly 
improved. Three other teeth were extracted with intervening 
periods of a few days, and in one week's time spontaneous hem- 
orrhage had almost entirely ceased from the mucous membranes 
of his body, and in four weeks' time he was back at his business 
with his clotting time reduced from eight and one-half minutes to 
three and one-half minutes. He had completely lost the hearing 
of his left ear at the time he came to us, as a result of a spontane- 
ous hemorrhage in his internal ear, which deafness persisted. 
He continued at his business with but slight interruptions for 
seven months when he had a hemorrhage in one of his eyes. This 
laid him up for a couple of weeks, after which he went back on the 
road. After a very hearty meal, while being entertained at a 
friend's home, he was taken with distress in his stomach. He 
came home and had a severe hemorrhage from his nose. This 
was followed by a distress in his abdomen which was diagnosed 
as peritonitis. He was taken to a hospital in a critical condition 
for surgical assistance and, according to the report of his wife, 
died in a few hours from a complication as an extensive hemor- 
rhage in both the abdomen and thorax. It seems probable that 



78 DENTALINFEC flONS & DEGENERATIVE DISEASES CLINICAL VOL.1] 



Private Records o( Weston A. Price. M.S.. D.D.S.. 8926 Euclid Avenue. Cleveland 

I ..mi No. u Serial N 

RESISTANCE AM) SUSCEPTIBILITY CHAR I 

Patient X.W.D. Co.Sc No. ' • 1 8 Age . 

Addkj SS |)AT1 I 



Ohio 



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Chorea or St. Vitus's 1 > ui> r 
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Heart lesions 



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Appendicitis 



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Pneumonia 



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Figure 280. Susceptibility history of patieni ^nd family. Case No. 1118. 



CHAP. LX CIRCULATORY SYSTEM CHRONIC CARDITIS 79 

he died in a condition strikingly similar to that developed in some 
of the rabbits inoculated with the culture from his teeth. This 
patient's hemoglobin was 70 and increased to 80. I lis erythrocytes 
increased from 3,250,000 to 4,700,000. The total calcium of his 
blood, ionic and combined, was only 8 mgs. 

Some of these dental strains have very marked effect upon the 
various cells of the blood. It is very frequently found that in 
patients with a streptococcal susceptibility, whether inherited or 
acquired, the secondary anemias exist. There may be an erythro- 
penia, two or three million, very often three and three and one-half 
million, which condition rapidly improves with the elimination of 
the dental infection. There may also be a very marked leucope- 
nia. This condition is so frequently found that its presence is a 
very important diagnostic symptom. These patients tend to have 
a leucocyte count of four or five thousand per cubic centimeter. 
A differential count may show a polynuclear count of forty to 
fifty-five per cent. These patients are in very poor condition for 
defense. They tend readily to systemic complications. With 
removal of their dental infections, this condition frequently very 
rapidly improves. In Chapters 19 and 20, I have shown that 
just as these patients have these typical changes in their blood 
morphology, the rabbits inoculated with the strains from dental 
infections very frequently develop similar changes, which is also 
true of the chemical changes in the blood. For more detailed 
reference to these blood changes, see all the charts in Chapters 
19, 20, 43, and 44. 

CHRONIC CARDITIS. 

There are many striking illustrations of the potential handicap 
of individuals born of an ancestry having a marked susceptibility 
to heart involvements. Such a case is strikingly illustrated in 
Case No. 412, a married man, aged forty-six, who has been suffer- 
ing from acute heart involvement. There has been a history of 
heart involvement since seven years of age. He is a semi-invalid. 
A history of the family and ancestry reveals that his father died 
of a heart lesion at forty-eight. His father also had rheumatism; 
four of his father's brothers had rheumatism and one had heart 
and kidney involvements. His mother had heart involvement, 
and her mother died of heart trouble. One of her sisters is an 
invalid with heart involvement. The patient's mother and her 
mother and one sister all have had rheumatism. He has had 
acute digestive disturbance not accounted for by food, as have 





y. 



80 



CHAP. LX CIRCULATORY SYSTEM CHRONIC CARDITIS 81 

also two brothers. This has been a serious affliction with the pa- 
tient's mother, and involved her mother, her brother, and sister. 
There has been left a very marked inherited susceptibility. 

Such a case history can only be considered unfavorably and the 
prognosis not good. If this patient has a locked area of dental 
infection, it will be almost certain to aggravate his heart condition. 
Since it is so nearly impossible, if not entirely so, to maintain the 
sterility of a tooth, no matter how well sterilized and how well 
root-filled, in the mouth of this type of patient having a lowered 
defense, we would say with confidence that this patient has no 
right to have a root-filled tooth in his mouth. His prognosis will 
always be bad. The removal of dental infection or any other 
scurce of focal infection will be very important as removing that 
much cverlcad. Absorption of toxic substances from the ali- 
mentary tract, nasal sinuses, or any other source, would tend to 
be a serious overload. Streptococci will grow in this man's body 
with very much greater ease than in the normal, and the propor- 
tion of streptococci in the bacterial flora of the mouth will be 
much greater than in individuals with a high defense for strep- 
tococcal infection. 

We have stated elsewhere that the seriousness of the patient's 
lesion together with the factor of safety, as interpreted from the 
susceptibility chart, will largely determine whether so-called 
border-line teeth will be left or extracted. If, for example, the 
patient is entirely well, but is young, and has had no serious 
overloads, and the history shows that he or she might be expected 
to have a strongly inherited susceptibility for heart or kidney or 
some such vital tissue, it is my judgment that such a person should 
not be permitted to carry a condition which might some day pro- 
duce the only other element required — namely, a source of 
streptococcal infection — to make possible a break in the heart 
tissue when the normal defenses become lowered. Sometimes, 
however, the break is already beginning if we have the foresight 
to recognize it. Such a condition is illustrated in the following 
case. 

Case No. 1118. — The patient at forty-five years of age was 
suffering from fatigue, heart, neuritis, and rheumatism, and for 
some time had been practically incapacitated for her work. The 
roentgenographic study of her teeth, as shown in Figure 281, 
revealed only one non- vital tooth : namely, the upper right bicus- 
pid. This did not have roentgenographic evidence of much local 



82 DENTAL INFECTIONS & DEGENERATIVE DIJ CLINICAL VOL. II 

structural change. We would consider this tooth border-line. 

Her susceptibility revealed, as shown in Figure 280, that her 
chief lesion is heart, that it has been progressively developing, but 

most important of all thai her lather and one of his brothers 
died of heart involvement, and that one of her father's sist 
was afflicted with a heart involvement. Her mother's mother 
died of heart and kidney involvement. Her brother had a heart 
involvement and her sister died of heart involvement. In other 
words, she has a strong susceptibility to heart involvement from 
both sides of the ancestry. 

We, accordingly, would expect that with a source of strepto- 
coccal infection and an overload, physically or nervously, she 
would tend to develop a heart lesion. We would not expect that 
the removal of such a tooth as shown in the upper right bicuspid 
would produce sufficient physical change in her body to make 
great change in the condition of her heart. We would, however, 
expect, and that with confidence growing out of our experience, 
that this tooth would be infected in its dentin with streptococcal 
infection. It was extracted and cultured internally and found 
to be infected with a Gram-positive diplococcus. 

An important procedure in this and all such cases is, we believe, 
the use of such means as may be possible to elevate the patient's 
attacking power for streptococcal infection, which is chronically 
low in this type of individual. For this we would recommend, 
and used in this case, an autogenous vaccine made from the 
organisms grown from the tooth. Results were very gratifying 
and her improvement marked, so that she was able to return to 
her profession of school teaching. I desire this case to be con- 
sidered as an emphasis of the need for making a susceptibility 
study, to ascertain the patient's probable inherited factor of 
safety, together with the patient's own record of such. 

As an additional precaution, we recommended that this patient 
see a throat specialist regarding the tonsils, which he recom- 
mended should be removed, on account of her general history 
rather than the positive tonsillar history. Her health has been 
excellent for two and one-half years up to the present, and she - 
again carrying full load, and that very comfortably. 

Our later study of these cases reveals that an inherent lowered 
defense is expressing itself primarily in a decreased bactericidal 
content of the blood. Their best is never high or adequate for 
combating an overload. With the reduction of overloads to the 



CHAP. LX CIRCULATORY SYSTEM MYOCARDITIS 83 

minimum, most important of which for them is a local strepto- 
coccal infection, they may have quite comfortable and efficient 

lives; and this is the type of patient namely, one having a low 
normal bactericidal content of the blood whom we may greatly 
assist with a properly closed and properly prepared vaccine, which 
was demonstrated in this case. 

MYOCARDITIS. 

These researches seem to be throwing an important new light 
on the probable etiology of many cases of myocarditis. Some of 
the most striking and gratifying improvements that w r e have ever 
seen have been in this type of patient. We have always con- 
sidered heart involvements of all types as being very serious and, 
indeed, we do still. We do not, however, look with such alarm 
upon this condition as we did formerly, having seen so many 
individuals take up again very vigorous life work and carry it 
without break for many years with both comfort and efficiency. 

In the next chapter under Respiratory System we discuss a 
case in which, with the suspected tuberculosis, there was severe 
tachycardia with lassitude and dyspnea on exertion, which has 
been entirely relieved by the removal of his dental infections, the 
patient having gained in weight from 122 to 176 pounds and has 
since taken large life insurance policies notwithstanding that he 
had been refused previously on account of his heart. In five 
years he has retained practically perfect health, carrying on an 
active business, and looks like an athlete. 

In Chapter 59 on the Application of Preceding Experimental 
Data in Clinical Practice, I have used as an illustration a patient 
who at twenty-three years of age was suffering from a very acute 
heart involvement and rheumatism, the former so severe that 
she could scarcely walk about. Within a few weeks, she gained 
from 131 pounds to 146, and for five years has retained her per- 
fect health notwithstanding the fact of a very marked hereditary 
susceptibility, both her father and mother having died of heart 
involvement between fifty and sixty years of age, as did others of 
the ancestry. 

It is very difficult in classifying cases, to prevent overlapping 
because of the frequent, if not general, tendency to complica- 
tions; that is, several organs or tissues will be involved at the 
same time in the one patient. The following is such a case. 

Case No. 1346. — The patient was forty-nine years of age and 
had been suffering what threatened to be a complete break in his 
health for the last three years. His chief distress has been in and 



84 DENTAL INFECTIONS & DEGENERATIVE Dl CLINICAL VOL.11 

about his heart. Physical examination indicated that the heart 
was enlarged and the apex rotated nearly to the nipple line. I [is 
disturbance had been previously diagnosed as myocarditis. The 
blood pressure was 180. He had a sensation of extreme tension 
in his head and symptoms which had been diagnosed as stomach 
involvement. He had had several thorough physical examina- 
tions including his mouth, and it had on each occasion been 
decided that the teeth were not involved, roentgenograms of 
which are shown in Figure 282. Our first impression from the 
roentgenograms was that his teeth were not sufficiently involved 
to be a serious contributing factor, if judged exclusively from a 
casual study of the roentgenograms. A more thorough study. 
however, revealed that the pulps were putrescent in both the 
second and third upper left molars, and exposed by caries and 
infected in the upper left first molar, none of which teeth showed 
apical involvement in the roentgenogram, but which conditions 
were evident upon careful physical examination of the teeth. 
The low angle of the upper right cuspid did not reveal clear evi- 
dence of apical involvement which, however, the high angle 





Figure 283. High angle view of upper 
right ci spid shown in figure 282. note 
difference in periapical appearance. 



view, shown in Figure 283, clearly reveals. 

The ionic calcium of his blood was much below normal. His 
blood sugar was 108; non-protein-nitrogen 19; urea 12. ."^eryth- 
rocytes 5,450,000; polymorphonuclear leucocytes 17.5; small 
lymphocytes 17.5 per cent. His features were drawn and expres- 
sive of great nervous strain and tension. A culture was made. 
anaerobically, from the pulp of the upper left first molar and 
from the contents of the putrescent pulp of the upper left second 



(.HAT IX CIRCULATORY SYSTEM MYOCARDITIS 

molar and inoculated into two rabbits. ( )ne died in about twelve 
hcurs with hundreds of sir all hemorrhages throughout the mus- 
culature of the body. These were found in both striated and 
non-striated muscles. These are shown in the chapter on Elec- 
tive Localization in Figures 152, 153, and 154. Figure 152 shows 
four views of this rabbit with its spontaneous hemorrhages in 
various parts cf the body. Figures 153 and 154 show spontane- 
ous tissue hemorrhages in several different rabbits, with the 
characteristic, that the specific quality which expressed itself as 
spontaneous hemorrhages, reduced as the culture increased :'n 
age. In the rabbit dying in twelve hours, and which received the 
earliest generations of the culture grown from his teeth, and 
which had hundreds of hemorrhages in various parts of its body, 
the heart was large and flabby and showed evidence of dilatation. 
The heart muscle showed a very remarkable condition. In addi- 
tion to the macroscopic hemorrhages visible in the heart and cor- 
responding with the macroscopic hemorrhages in other tissues of 
the body, the heart muscle showed, when sectioned, exceedingly 
profuse interstitial hemorrhages. These had been so violent as 
to rupture the connective tissue. This is shown in Figure 284. 
The upper left molar was planted beneath the skins of several 
rabbits in succession, the first five of which produced definite 
lesions, the first with hemorrhagic myositis, with spontaneous 
hemorrhages; the second, hyperemia of the myocardium, muscle 
atrophy, and edema of the kidney; the third, acute appendicitis, 
minute hemorrhages of the wall of the large intestines, and 
hyperemia of the myocardium, liver, and kidneys; the fourth, 
hyperemia of the heart and liver, and muscle atrophy; and the 
fifth, hyperemia of the myocardium and kidneys. 

The patient was placed on the following program : A diet rich 
in calcium, consisting of from three pints to two quarts of butter- 
milk or sweet milk per day, calcium lactate in tablet form, para- 
thyroid one-tenth grain daily, reduced later to one-twentieth 
grain daily. 

The postoperative condition following the extraction of the 
three upper left molars was that a secondary hemorrhage set in a 
few hours after the extraction, which persisted for hours and was 
very obstinate, requiring the patient to be kept in the ward with 
nurse's attendance for the night. This is particularly important 
in connection with the effect of the culture on the inoculated 
rabbits which developed spontaneous hemorrhages in the muscles. 



86 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL II 







FlGUM 284. SE< riON OF HEART WAN OF \ RABBIT WHICH DIED IN WELVE HOURS FROM SPONTANEOUS 
HEMORRHAGE FROM TOOTH CULTURE OF CASE NO. L346. SEE VLSO FRONTISPIECE C. 

After the extraction of the first three teeth and the treatment 
that was instituted, no further hemorrhages were experienced. 
The other extractions followed in a few days. The general result 



CHAP. LX CIRCULATORY SYSTEM MYOCARDITIS 87 

was that in ten days' time the patient's ionic calcium of the blood 
was back to normal. His general physical state had improved so 
greatly that he stated that he had not felt so well for three years. 
His appetite was excellent and he slept well. The vital index of 
the polymorphonuclears showed marked improvement. The rela- 
tion between the ionic calcium and the general condition of the 
patient was characteristic of this type. When the ionic calcium 
was low, he had to drive himself with a whip, being in a state of 
intense lassitude and nervous irritability. He expressed the 
former condition as one in which the feeling of his head was as 
though he had been struck over the head with a club, and it was 
almost continually sore or under sense of severe tension for 
months. This sensation completely disappeared. He stated that 
he had not felt as well at any time for three years as he did within 
ten days after these first extractions and the starting of the 
special treatment. 

A piece of the root of the upper left second molar was placed 
in some of this patient's blood serum to determine its effect upon 
the blood calcium. This piece of root furnished enough toxin to 
combine with approximately one-tenth of the available ionic 
calcium of this serum in 1 cc. in one-half hour's time, or a total of 
approximately 30 per cent, when added to the already combined 
calcium. 

Whereas, before the removal of his dental infections and his 
treatment, he was in such serious condition that he could not 
carry on business and at times could scarcely carry on a conver- 
sation because of the sense of distress produced by having to 
think, which symptoms were more aggravated for an hour after 
eating, at which times he would not dare to walk a block because 
of the distress about his heart, since the removal of the dental 
infections and treatment, and beginning within a few days and 
rapidly improving, the heart irritation has entirely disappeared, 
as also the distress related to eating, and he is entirely free from 
the nervous disturbances and mental irritability. W 7 ithin a few 
days he was walking several blocks, and in a few weeks was carry- 
ing on business practically without limitation. He has gained 
in weight and a feeling of well-being and joy was clearly ex- 
pressed in all his features in place of the haunted nerve tension 
that clearly demonstrated that he was just at the point of nervous 
crisis. 




KK DENTAL INFECTIONS^ DEGENERATIVE DISEASES CLINICAL VOL. II 







Fk.i re L'. v r>. Spontanea s hem< rrhages in tiik.ii qf one rabbii and psoas muscles of another rabbit. 
Tooth ci lture fr< m Case No. 1346. 

Illustrations of the spontaneous hemorrhages produced by both 
culture and the implantation of his infected teeth in other muscles 
than the heart are shown in Figure '285. in which A shows hemor- 
rhages into the hind leg of a rabbit, and B. hemorrhages- into the 
psoas muscles of the back. This case is discussed also in the 
chapter on Digestive Tract in relation to the type of lesion ex- 
pressed in the stomach. 



CHAP. LX CIRCULATORY SYSTEM MYOCARDITIS 89 

For those who are interested directly in the elective localiza- 
tion quality of the organism found in this case, we would state 
that in ten rabbits inoculated, nine showed spontaneous hemor- 
rhages and the tenth showed hyperemia of the myocardium. 
This should be thought of in connection with the fact, that the 
patient net only had the heart involvement, which had been 
interpreted as a myositis, and which condition was apparently 
quite perfectly relieved, but also had an exceedingly severe 
secondary hemorrhage following the removal of his dental infec- 
tions. This elective localization quality tended definitely and 
rapidly to diminish with time. Only the first generation of 
organisms produced the sufficiently severe spontaneous hemor- 
rhages to cause death. In this connection it should also be noted 
that even the implanted tooth produced spontaneous hemor- 
rhages. 

"7 •* . ^. -,»» 




-»» 









Figure 286. Smear from the urine of Case No. 13i6, showing manv pus cells which 

ENTIRELY DISAPPEARED AFTER THE REMOVAL OF DENTAL INFECTIONS. 

The urinalysis before the removal of the dental infections 
shewed both hyaline and granular casts and pus cells in large 
numbers, arranged largely in shreds as if formed into such in the 
glomeruli. Figure 286 shows a smear from his urine with 
polymorphonuclear leucocytes and diplococci. This condition 
entirely disappeared with the removal of his dental infections. 



90 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 




CHAP. I.X -CIRCULATORY SYSTEM MYOCARDITIS 



91 



Private Records of Weston A. Price, M.S.. D.D.S., 8926 Euclid Avenue, Cleveland, 

Form Mo. 13 Sei ial So, I 



Ohio 



RESISTANCE AM) SUSCEPTIBILITY CHART 

t>AT1ENT I-YV.T?. Ccuse / Vo. 13,3.*- Ace 
Address Date /y c 

Clin i- Co.mpi. \ : \ W QTie/ 



KlIKl'MATK ' ■ ROUP 

Lesions \ m • 
Compuic ITIONS 



It 



+ 



— 



So. 



Tonsillitis 



Rheumatism 



Swollen or lKiormed [oints 



Xeck-lxtck or Shoulders 
Lumbago 



Xenntis 



Sensitizations 



Sciatica 



Chorea or St. Vitus's Dance 



Nervous lireakdou n 



Mental Cloud 
Persistent I leadache 



-j^^ 1 lean Lesions 
Dropsy 



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Kidney Legions. I'.n^lHs. 



Liver or ( .all Lesions 

Appendicitis 



Stomach pain or I 'leer 



1 ■• i 1 r.- Skin Shingles 
Pneumonia 



Anemia 



< '.(liter 



Lassitude. Chilliness 



Hardening of Arteries 



Stroke 



Age it Living 



Age at Death 



Flu with Complications 



Flu without Complications 



fr-mi'i" 



Cro up 



Extensive Tooth Decay 



Abscessed Teeth 



Loosening Teeth 

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CH*«I -ff Frequently 



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FACTOR OF SAFETY 
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Figure 288. Resistance and susceptibility record of family and patient of Case 
No. 133o. Note five deaths on father's side. 



92 DENTALINFEC riONS & DEGENERATIVE DISEASES CLINICAL VOL. II 

Many individuals present for dental operations with every 
evidence of having excellent health and of high defense, who have 

a matter of fact a very serious handicap in the form of a marked 
susceptibility which cannot safely be ignored. Such a case is the 
following, whose roentgenograms are shown in I- igure 287. C 
No. 11^35). She looks well and at the time of presenting says -he is 
well. A study of her case would readily, of course, condemn the 
lower right second molar. Since her health is reported so good, 
it would be very natural for some of the other root-filled teeth to 
be passed without suspicion. This is the type of case where very 
great harm might be done if the operator either through igno- 
rance, carelessness, or lack of time, neglects to take the history. 
Notwithstanding that the girl is apparently in splendid health 
now, her history shows that she was laid up with enlargement of 
the heart for one and one-half years following the Flu in 1918. 
Her susceptibility chart is shown in Figure 288. It will be seen at 
a glance that her father died at fifty-eight of heart involvement, 
her father's father at fifty with heart involvement, two of her 
father's brothers and one of the father's sisters all dying of heart 
involvement; in other words, five members of her father's family, 
including her father. This shows an inherited susceptibility of so 
great a strength, that, even though she had never broken, we 
would be very fearful for fear she would. The fact that she has 
done so, following the Flu, throws very great responsibility upon 
the dental infections which she carried at the time of her Flu, for 
as we have shown in the chapter on Overloads, more than twice 
as many people were found to have developed complications with 
the Flu in a group having dental infections as in the group without 
the dental infections. It is clearly our duty in this case to remove 
all root-filled teeth. With this evidence of streptococcal suscepti- 
bility I would say that the chances are more than 999 cut of 1.000 
that every root -filled tooth in her head carries streptococcal in- 
fection, for in the thousands of teeth that we have cultured, we 
have practically always found the root-filled teeth, which have 
been under suspicion, to be infected within the tooth structure. 

There was one item in this case which should arouse suspicion, 
at least to the extent of making inquiry : namely, that this patient 
was apparently and actually decidedly underweight. In another 
chapter we have discussed the frequency of underweight in 
streptococcal susceptibility. 

While dictating this part of the text of this chapter, there has 



CHAP.LX CIRCULATORY SYSTEM MYOCARDITIS 93 

come in the mail a typical communication from a member of the 
profession of another state, who stands far above the average, and 
in the best ten per cent, so far as judgment, training, and experi- 
ence would be expected to place him. His inquiry is so typical of 
the plight of the profession in general that I would use his case as 
an illustration. He presents the roentgenograms that had been 
made for his patient with the recommendation that certain root- 
filled teeth be extracted, and expresses the wish that, if possible, 
they may be saved. He desires an expression of my judgment 
before deciding. Incidentally, he gives this information about 
the patient. He is suffering from enlargement of the heart and 
from angina pectoris. 

This is just such a communication as I am receiving frequently 
except that the symptoms of the patient will vary, but similar in 
the very little detail that is given, such as the age of the patient, 
how long he has been suffering, etc., etc. In the first place, it is 
impossible correctly to read the roentgenograms without a physi- 
cal examination of the patient's mouth, or to make such tests and 
direct examinations as will disclose non- vital teeth whose pulps 
have not been removed, etc. The roentgenograms show evidence 
of apical involvement with condensing osteitis; and, notwith- 
standing evidence of considerable deficiency in root fillings, 
there is not a considerable periapical alveolar absorption. 
The fact that there is not as much as the physical conditions 
of the roots would suggest might be expected, together with 
the brief statement regarding the patient's condition, that 
he has an enlarged heart, (for these latter immediately 
suggest a low systemic defense for streptococcal infection,) 
suggests that we should expect in such a case, as we have 
shown, very little apical alveolar absorption. In other 
words, this patient would, in all probability, fail to establish an 
adequate quarantine immediately about the tooth, and because of 
the absence of this the bacteria and their toxins could pass beyond 
that quarantine and would have to be dealt with throughout the 
body, and would tend to attack the most susceptible tissue. His 
case resolves itself then, since we are dealing with an organ that 
is vital to health, into a choice between taking the chance of his 
living a longer time with fewer of his own teeth and dependent 
upon artificial substitutes, or a probable shorter life without 
artificial substitutes. If I were a betting man, my research ex- 
perience would justify me in betting a thousand to one that every 




94 



CHAP. LX CIRCULATORY SYSTEM MYOCARDITIS 95 

one ol" the root-filled teeth in question in this patient's mouth is 
infected in the dentin. This would not necessarily be a serious 
situation for a constitution that was so organized that it could 
adequately defend itself against the invasion of infections and 
toxins immediately at the portal of their entry into the system— 
namely, the vicinity of the root apex- but it is a profoundly 
serious matter for a man with so much evidence that he is failing 
in that very defensive process, both as revealed by the condensing 
osteitis and his carditis. His enlarged heart, in all probability, is 
the direct result of streptococcal invasions, first as petechial 
hemorrhages followed by their subsequent fibrosis with, or with- 
out direct bacterial infection. 

Two things, in particular, must be kept in mind regarding this 
type of invasion: First, that one streptococcal invasion pre- 
disposes to another; and second, that the dominant character- 
istic of the organisms with which we are involved is their ability 
to accommodate themselves to the environment and culture 
medium that any particular patient may tend to furnish, which 
quality must dominate in the absence of that similar quality, 
which constitutes the efficient mechanism of defense of the pa- 
tient whereby the patient as a multicellular organism readjusts 
itself to every counter move of the bacteria and maintains with- 
out a moment's failure the adequate quarantine by a chemical 
process of combating the organism and its toxin as far as it comes 
within its reach about the hiding place — namely, the patient's 
infected tooth — for these chemical substances of defense cannot 
enter, as we have shown, an infected tooth and stamp out the 
source of supply. Yellow fever has been almost completely 
banished from the face of the earth in a very few decades by the 
stamping out of the source of infection and the carriers, the 
mosquitoes. Our human bodies can do this with, practically, 
every other infected structure of the body except the tooth. 

In Chapter 21 we have discussed the relation of overload of 
several closely consecutive pregnancies and illustrated with 
patients, one of which group is illustrated in the following: 

Case No. 1009. — She was brought to us, in a wheel chair, so 
severely weakened from heart involvement and deformed from 
arthritis that she could only stand a moment, and that with 
great difficulty, taking very few steps. Her weight was 78 
pounds and her height was about 5 feet 4 inches. At three years 
of age she had infantile paralysis, but as a girl had nearly normal 



96 DENTAL INFECTIONS & DEGENERATIVE DIS CLINICAL VOL.11 

strength, had been engaged in business, and when married had 
good health. The roentgenograms of her teeth are shown in 
Figure 289. The family history on the lather's side was excellent ; 
not so on her mother's side. Her mother and grandmother and 
two of the mother's sisters, all died of heart involvement. This 
girl had three miscarriages in two and one-half years, all closely 
following a full term birth. The result of this overload was to 
bring on an acute rheumatism and deforming arthritis and heart 
involvement. We would expect from the type of early reaction 
around the necks of her teeth that she had normally a high de- 
fense, since, as we have shown, a capacity for a good reaction is 
evidenced by the destruction of alveolar bone and gingival tissues 
in the presence of irritants. Cultures taken from her teeth \\ 
inoculated into five rabbits, every one of which developed cardi- 
tis, four as endocarditis, and one as myocarditis and aortitis 
This patient's weakness was very marked and she was a very 
great sufferer, frequently not being able to sleep a moment during 
an entire night, from the pain. She had never been able to regain 
her strength after the depression of her frequent pregnancies. 
The use of an autogenous vaccine made from the culture of he' - 
infected teeth, together with the removal of the infected teeth, 
produced so great a change that she was able to go about the city 
alone in a few months' time and was practically free from pain 
and has progressively improved to the enjoyment of very com- 
fortable health and few serious physical limitations. 

We would interpret her case as fellows: She inherited a good 
defense from her father's side and a susceptibility to heart infec- 
tion from her mother's side. Under normal conditions she had 
normal health. In the presence of her unusual overload she 
became a prey to streptococcal infections to which she was. by 
inheritance, susceptible. > from all available sources, important 
among which were the teeth. She was not able to regain control 
of this handicap without the removal of the principal source of 
infection namely, her teeth and the boosting of her defenses 
by means of a vaccine. Her margin of safety is low. at best, and 
now always will be lower than before, because of the carditis, and 
infantile muscle atrophy, even though she seems quite well. 
\\ ith a recurrence of overload, which may be Flu. or. as before, 
she may be expected to break and particularly so. if there be 
present at the time within her system, a focus of infection to fur- 
nish the type of organisms to which she is so sensitive. The 
knowledge of the inherited susceptibility for heart involvement so 



CHAP. LX CIRCULATORY SYSTEM MYOCARDITIS 97 

strong from her mother's side places an entirely new and important 
responsibility upon her dentist, upon herself, and her husband. 
This is the type of case that will likely break with another preg- 
nancy, unless very great care be taken to keep her calcium reserve 
as high as possible. 

A striking illustration of inherited susceptibility to disturb- 
ances in particular tissues or organs of the body will often be 
found associated with this most important organ of the body, 
the heart, and, no doubt, constitutes one of the major afflictions 
of mankind. Previously in this chapter I have discussed as Case 
1346, a condition that had been diagnosed as myocarditis which 
was apparently entirely relieved by the removal of dental infec- 
tions. Cultures taken from the tooth of that patient produced 
profuse hemorrhages into the muscular tissue of the heart, when 
injected into a rabbit, as shown in Figure 284. This individual's 
daughter (Case No. 1414) presented later with symptoms of 
nervous break, much lassitude, and a pain about her heart. Two 
things are very important in this connection: The first is that 
with the removal of her dental infections her heart disturbance 
was entirely relieved, as were also her nervous symptoms, and 
she, like her father, made very important and rapid improve- 
ment. The other important thing is that when a culture from 
her tooth was inoculated into a rabbit, there was a very marked 
disturbance of the heart, both as endocarditis and myocarditis. 
Figure 290-A shows a section of the heart muscle with multiple 
areas of infection, some of which involved zones are large. The 
heart wall was thickened and there was distinct evidence of 
fibrosis; and even though the heart lesion was so severe, the heart 
was still functioning splendidly when the rabbit was chloroformed 
for posting. B shows a higher magnification of one cf these zones, 
which shows a profuse round cell infiltration and a beginning of 
degeneration. In some of these zones, however, degeneration 
had gone on to a process of necrosis and vacuolization, as shown 
in Figure 291. 

It is important in this connection to emphasize again the type 
of dental pathology that was expressed in this individual. In 
Chapter 42 of Volume One I have shown for comparison the 
roentgenographic and blood chemical analysis studies of two 
patients presenting the same day, one with a high, and the other 
with a low defense, and I have discussed there some fundamental 
factors involved. The patient with high defense furnished a 
















• 









l-'lci II 290. \ VERY SEVERE MYCX tRDITIS PRODUCED IN THE HEAR! OF \ RABBIT INOCULATED WITH CULTURE 
PROM C VSE NO. 1414. A. LOW POWER; B, MEDIUM POWER OF FOCALIZATION. 



CHAP. L> CIRCULATORY SYSTEM MYOCARDITIS 



99 




Figure 291. High power of severe myocarditis produced in the heart of a 
rabbit inoculated with culture from case 1414. shows extensive necrosis, 
fibrosis, and vacuolization, which was not yet fatal when chloroformed. 

blood that was very efficient in bactericidal property, besides 
which it had a capacity, when vaccinated, to have this high 
efficiency exalted, whereas this patient, Case No. 1414, furnished 
a blood with exceedingly low bactericidal property and which, 
when vaccinated in vitro, showed no capacity for an increase of 
that function. I have also shown in that chapter the typical 



100 DENTAL INFEX I IONS& DEGENERATIVE DISEASES C LINICAL VOL. II 

difference in the roentgenographic expressions of irritations about 
the teeth; and since there is so much to be learned from a careful 
study of that great truth, I deem it of sufficient importance to 
show in this connection the roentgenograms of the teeth of both 
of these patients, which are presented in Figures 292 and 3. The 
teeth of this patient are shown in 293, and it will be noted that 
three pulpless teeth the lower right first molar, the lower left 
second molar, and the upper right second bicuspid show very 
little evidence of periapical reaction, notwithstanding there is 
much occasion for it, particularly in the upper bicuspid and the 
lower right first molar. In comparison with this, note that the 
companion picture of the teeth of the individual with the high 
defense, who has never suffered any of the rheumatic group 
lesions, shows very extensive gingival and periapical change from 
irritation. 

For those dentists and physicians who are want to make their 
decisions on the presumption that the extent of the apical in- 
volvement, as expressed roentgenographically, is a measure of 
the danger, I would urge that they refer occasionally to the dif- 
ference in the bactericidal capacities of the bloods of these two 
patients, as shown in Figure 248 of Volume One. Since the other 
volume of this book may not be conveniently near for immediate 
reference, and because of the great importance of this matter. I 
am presenting that illustration again here in Figure 294. If 
that condition obtained in a child of mine, I would not lor a 
million dollars permit those teeth to remain, for from my inten- 
sive study of this problem, it is my judgment that the probability 
of this girl's going through life without further serious injury 
from these teeth, is not one in ten, granting that she will have 
the average overload of a normal life. She is a chip off of the old 
block and has already proven it; and, after all, is that not true of 
most of us? The difference in the value of the comfort of life 
without the injuries which these teeth can produce, when com- 
pared with the possible discomforts of living and eating with 
artificial restorations, is so great as to make an effort at compara- 
tive values a mockery. We do well to remember that the cracked 
china cup max last longer than any cup in the cupboard, but only 
because it is better taken care of. We should also always keep 
before us the fact that approximately one in ten of all deaths is a 
life gone out years too soon because of a secondary involvement 
which has injured the heart. 




101 






102 DENTAL INFECTIONS & DEGENERATIVE DISEASES i LINICAL VOL.11 







Figure 294. Comparison of bactericidaj properties of rwo bloods: Case 1414, very low; Case 1415, 

VERY HIGH SEE DIFFERENCE IN DENTAl PATHOLOGY IN FIGURES 292 WD 293. 



CHAP. LX CIRCULATORY SYSTEM MYOCARDITIS 103 

Another phase of myocarditis has to do with those degenera- 
tive heart conditions which are the result of long standing irrita- 
tions. It not infrequently happens that patients who are making 
a supreme struggle in every tissue of their bodies to carry on, go 
down with a crash with a disturbance of dental infections in the 
presence of a heart overload that is already involving the capac- 
ity of the powers of adaptation. Probably I hear cf more of 
them than I would in general practice and were I net engaged in 
research, but it does seem that scarcely a month goes by that 
I do not hear of a death following dental operations. Unfortu- 
nately, the public mind does not know that the individual whose 
life has gone out, took to the dentist a condition that was almost, 
if not entirely too late for repair, and the dentist is generally too 
severely criticized. The time must come, however, when methods 
will be developed whereby the average practitioner can deter- 
mine what cases constitute legitimate risks and what do not. 

It is not only the patients with acute heart involvement that 
should have this consideration, for many other individuals have 
extremely grave conditions from the standpoint of surgical pro- 
cedure. This is true particularly of those individuals suffering 
from a marked depletion of their alkali reserve. Even though 
the organs of their bodies are functioning with relative efficiency, 
they are entirely incapable of taking care of the additional toxic 
products which will be provided by the breaking down of tissues 
as well as by the setting free of both bacteria and toxin from the 
infection in the area. Many of these patients look fairly well, but 
their appearance is very deceiving. In the chapter on Osteo- 
myelitis in Skeletal Diseases I have discussed a case which shows 
in quite considerable detail the relation of defense to alkalinity 
index of the blood. It is most gratifying that since we have de- 
veloped the information presented in these two volumes, we 
have not had a single serious or grave sequence following surgical 
procedure, and I think entirely because we have a basis for judg- 
ment in determining what operation may be considered safe for a 
given patient before any operations are undertaken. 

It has long been known that diabetics constitute exceedingly 
poor risks for surgical procedures. While this is general knowl- 
edge, it probably is not generally understood that probably the 
most important factor in diabetes, contributing to making these 
individuals a poor risk, is the greatly depressed alkali reserve ; in 
other words, they are in a chronic state of acidosis. At this point 



101 DENTALINFEC I l< NS & DEGENERATIVE DISEASES CLINICAL VOL. I] 

it is well for me to make an important distinction. I have fre- 
quently referred to the fact, that patients with a marked sus- 
ceptibility to periodontoclasia make a splendid repair after ex- 
tractions, and I have also stated that diabetics tend to have 
periodontoclasia, and vice versa. It is therefore most natural to 
make the conclusion that diabetics make a good repair after sur- 
gical procedure. The facts are that diabetics constitute a dis- 
tinct divergence from the general group which would be sus- 
ceptible to periodontoclasia. This is evidenced in many ways, 
only one of which is this lack of readiness to healing, another 
being the lack of response of pyorrhetic conditions to treatment 
and both for the same reason. This condition, too, is true of all 
individuals with marked acidosis, or distinctly depressed alkalin- 
ity index. 

All of this is preface to the presentation of a case which illus- 
trates the need for an adequate examination of the patient before 
beginning extensive dental procedures. The case is that of a 
man thirty-four years of age, Case No. 1057, whose chief dis- 
turbances were heart, rheumatism, and digestive tract, with ex- 
treme nervous irritability. There was a history of attacks of 
rheumatism at five years of age, twenty-five years of age, and 
twenty-eight years of age. His heart trouble was first recognized 
about four years ago; he fatigued in walking a few blocks 
with much shortage of breath, which began about four or five 
months prior to examination. He was brought by a physician 
who greatly desired that we hasten our operations as rapidly as 
possible. As he had recently been to a sanitarium and had pretty 
complete studies made, we accepted their reports as a basis. 
We, however, took the precaution to insist that he stay in the 
ward for a day for observation before making extractions. The 
first two attempts to make surgical procedures were abandoned 
because of the patient's condition. His physician was present 
and urged that we proceed, since he was going from bad to worse 
and since he had so much dental infection that probably was an 
important contributing factor. With extraordinary precautions, 
one or two teeth at a time were extracted on three occasions. He 
was kept under careful observation in the ward with our- pathol- 
ogist watching his heart condition which was not the most dis- 
turbing symptom. While there was evidence of improvement in 
some of his conditions, his general condition grew progressively 
worse, and in twenty-eight days from the time of our first opera- 





B 



Figure 295 Two severe heart lesions produced in rabbits inoculated with 
culture from Case No. 1057: A. myocarditis with hypertrophy; B. endocarditis. 

105 



L06 DENTALINFEC TI0NS4 DEGENERA1 I\ EDISEASES i LINK M. VOL. II 







Z 

7 



— j 

■z. t- 
2 



- u 

- - 
Z < 






— _ 
- 
j 



CHAP. LX CIRCULATORY SYSTEM CARDITIS 1()7 

tion he deceased with symptoms of extreme acidosis. 

I do not know of any procedure which would have made this 
grave condition a safe one for surgical operation. In the first 
place, the removal of the dental infections was much toe greatly 
delayed. I feel quite sure, however, that had we at that time 
been making determinations of the alkalinity index as we do now 
in all questionable cases, that we would not have undertaken an 
operation until he was in better condition, which probably could 
have been obtained by antiacidosis treatment. Cultures were 
taken from his teeth and were inoculated into rabbits, the hearts 
of two of which are shown in Figure 295. The one in A shows 
a very great hypertrophy, and the one in B vegetations on the 
heart valve. Some of his dental conditions are shown in Figure 
298. 

In several chapters of Volume One and in this and the preced- 
ing chapter of this volume I have stressed the fact that the differ- 
ence between relative safety and danger from focal dental infec- 
tion is largely a matter of defensive capacity of the host rather 
than the attacking power of the bacterium involved. In individ- 
uals with a high defense the mechanisms of attack upon the 
invading organisms are sufficiently active not only to destroy the 
organisms in the territory adjacent to their source but will tend 
to destroy them at every point where they are accessible to those 
defensive forces. I have also demonstrated that the mechanical 
structure of the tooth with its approximately three miles of 
closed channels in a single-rooted tooth, constituting the tubuli 
of the dentin, constitutes a protected zone into which the forces 
of defense cannot enter. In individuals with an adequately high 
defense, therefore, there is a solution process established by the 
host, which slowly but progressively takes down the fortress by 
absorption of the infected tooth, thereby ultimately making 
accessible all of the organisms for annihilation. I have also 
shown in Chapter 42 that part of the protective mechanism is the 
building of so efficient a barricade between the source of infection 
and toxin and the host that the products of the warfare may by 
their mechanical pressure break a channel to an external sur- 
face and there escape, and in so doing start an exit for the exfo- 
liation of the infected sequestrum. It is very unfortunate that 
so many of the members of our profession find themselves in 
antagonism to the thought that root-filled teeth may be to a 
greater or less extent an infected sequestrum, without having 
sufficient experimental data to justify their conviction that the 



108 DENTALINFEC [TONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

same is not true, which conviction I fear is largely based upon 
clinical symptoms, all of which are in their more nearly correct 
analysis evidences of an adequate defense, which latter makes 
that tooth relatively safe only so long as that relatively high 
defense is maintained. 

In order to assist in the visualization of what is involved in this 
process of defense I wish to call attention again to the fact that 
an important part of the defense against bacteremias from focal 
infections is the capacity of the host to build a protecting mem- 
brane around the infected sequestrum and so to vitalize it with 
defensive fluids, including the defensive cells of the blood, that 
fcr all practical purposes an adequate quarantine is established 
and maintained. In Figure 297 I show in A such a cystic mem- 
brane organized around the broken up chips of an infected tooth, 
which were sufficiently fine to pass through a medium sized 
hypodermic needle. The rabbit was later chloroformed and this 
encysted material removed for sectioning and further study. 
C shows a cross section, and it will be noted that a dense fibrous 
capsule has been built around the pieces of infected tooth struc- 
ture. It is very highly vascularized and there is evidence of a 
very efficient mechanism of defense, both from the local struc- 
tural conditions and from the clinical, for the rabbit gained in 
weight from 1185 to 1539 grams, amounting to 30 per cent in 
sixty-nine days, at which time it was chloroformed for study. 
On posting no systemic pathology was found. Locally a cyst had 
been formed and was removed for study. 

PHLEBITIS. 

It seems probable that we have not given due consideration to 
focal infections as playing an important role in the etiology of 
phlebitis. In so far as I know, it has not been suggested that 
dental infections are involved in the etiology of these processes. 
While there are many types of inflammation, certain general con- 
ditions are usually present, such as infiltration of the coats of the 
vein with the formation of a thrombus of coagulated blood. The 
swelling, stiffness, and edema, frequently produce a great deal of 
pain, and with these it is very troublesome in its more severe forms 
in which there is the breaking down of tissue with the develop- 
ment of local necrotic processes. In its simpler forms the chief 
symptoms are the swelling, edema, and pain. One of our pa- 
tients Cast.' No. 1048) had been suffering severely from this dis- 
turbance and after her recovery presented for the study of her 




Figure 297. Defensive reaction: A. encapsulated tooth chips; 

B, ORGANISMS IN SAME; C, FIBROUS ENCAPSULATION TISSUE. VERY VASCULAR. 

109 



110 DEN1 \l. [NFEC TIONS« DEGENERA1 IVE DISEASES CLINICAL VOL II 









■^ 




Figure 298. A severe c ^se of phlebitis, produced in a rabbit's 

EAR BY INOCULATION WITH A CULTURE FROM A TOOTH OF A PATIENT WHO 
HAD RECENT! V -i FFERED FROM A SEVERE ATTACK. 

dental infections in connection with her digestive tract disturb- 
ance, localiz'ng particularly in the Liver and gall-bladder. The 
cultures taken from her tooth not only showed the acute infective 
involvement of the gall-bladder, with multiple ulcers as shown, 
but also localized in the blood vessel walls of the rabbit. In 
Figure 298 we show this rabbit's ear which is swollen ten to 
twenty times its normal thickness, very red. edematous, and 
painful to touch. This, of course, does not prove that this pa- 
tient's phlebitis was in any way connected with her infected tooth. 
Thi' fact, however, that this lesion is very rare in our experimental 
animals leads me to suspect that there was some connection, 
which would be entirely in keeping with our knowledge to date 



CHAP. LX C I RCT1.ATORY SYSTEM HYPERTENSION 111 

regarding elective localization qualities and the conditions under 
which they express themselves as such. 

HIGH BLOOD PRESSURE. 

The etiology of hypertension and hypotension is exceedingly 
difficult to determine. High blood pressure tends to be associated 
very often with renal disease and tends to develop, in many cases, 
carditis. It, therefore, is a relatively serious manifestation. I 
am coming to associate certain types of dental infections very 
frequently with a type of abnormal blood pressure, which tends 
to fluctuate in a marked degree. In the case referred to under 
heart block, that gentleman, seventy-five years of age, had a 
blood pressure, varying from day to day, from 125 to 175. In 
ether cases the blood pressure tends to remain abnormally high. 
Such a case is the following, and this also, like the one just re- 
ferred to, is related to a dental cyst. 




Figure 299. A dental cyst 

WHICH PRODUCED A HIGH BLOOD 
PRESSURE REACHING ABOVE 220, 
COMPLETELY RELIEVED BY ITS 
REMOVAL. 



Case No. 796. — This woman, aged forty-seven, had a blood 
pressure in the vicinity of 220, above and below. She had very 
marked distress in her head, was almost incapacitated, and the 
symptoms were quite alarming. The prognosis had been given 
by her medical attendant as very bad. In the roentgenogram 
shown in Figure 299, there will be seen a bone cyst in the mandi- 
ble, beginning at the apices of the roots of the first permanent 
molar and reaching nearly to the lower border, but encased in the 
structure of the mandible. With the removal of this and the two 
adjoining teeth and curettement of the cyst chamber, her blood 
pressure, which had been high for over a year, rapidly descended 
to 125 and has remained in the vicinity of normal ever since. Her 
physical condition has returned completely to normal; she has 
again taken up her duties, and for several years has had no ten- 
dency to reinvolvement. It is also of interest to note that a few 
years prior to the development of her high blood pressure she had 



L12 DENTAL INFEC I I0NS4 DEGENERATIVE DISEASES CLINICAL VOL. II 

an operation for the removal of an exceedingly large ovarian 
cyst. In the light of our studies recorded in Chapter 62, it is 
particularly suggestive that her dental infection may readily have 
been the origin of this ovarian cyst. 



CHAPTER LXI. 
RESPIRATORY SYSTEM. 

DISCUSSION. 

There are two distinct ways in which dental infections very 
directly contribute to, or become confused with, tubercular and 
pneumococcal infections of the lungs and respiratory tract: 
namely, they may be additive to these other infections, or may be 
confused and mistaken for them. There is need for a great deal 
of very careful research work in this field, for, it not infrequently 
happens, that the interference with dental infections of patients 
suffering from lung involvements, very greatly aggravates that 
condition rather than relieving or correcting it. We have seen 
lives go cut very rapidly after the breaking up of dental infections 
where there was involvement of the respiratory tract. Also, as 
we shall illustrate, we have seen cases of exceedingly marked 
improvement and apparent complete recovery as a result of the 
removal of dental infections. 

While we may, in a general way, be able to visualize the differ- 
ences between these groups, the information available does not 
justify presentation at this time of a set of rules. In a number of 
instances where patients with a marked susceptibility to strep- 
tococcal infections have developed pneumonias, our examination 
of the sputum has revealed a practically pure culture of strep- 
tococci, usually in diploid form; and, indeed, I have come to 
believe that the pneumonias of this type of patient are either 
complicated with streptococcal infection, or the result, primarily, 
of invasion by that organism. Of the tubercular complications 
and cases interpreted as tubercular, which are not, but are strep- 
tococcal, while there is quite a large number in each group, it would 
be very difficult to prove conclusively the presence or absence, 
with certainty, of the tubercle bacillus since that organism is so 
easily overlooked. 

One of the symptoms of streptococcal infection which adds 
very greatly to the confusion with the tubercular infection, is the 
fact of a recurring afternoon temperature. The streptococcal 
curve with its weakness and cough would cause many to class 

113 



Ill DENTAL INFEC I IONS & DEGENERATIVE DISEASES CLINICAL VOL. 11 

that symptom group with tubercular infection. One of the fre- 
quently present differentiating symptoms, although only sugges- 
tive, is the fact that tubercular patients do not suffer from mental 
cloud as a direct effect of the toxin of that organism, which re- 
action is very likely to be present in patients suffering from 
streptococcal infection. While the tubercular patient is always 
going to get well, and hopeful, and confident to the day of death, 
the streptococcal patient tends, on the contrary, to be dis- 
couraged and fearful of an impending doom, which may take any 
phase from hysteria, or even insanity, to an extreme nervous 
activity, even expressing itself in an exalted mental efficiency. 
Indeed, some of the best products of the human brain have been 
done under the stimulation of this whip. 

We would present as an illustration of the role of dental infec- 
tion in a case of so-called tubercular infection of the two above 
types, the following: Case No. 345. — This patient, aged fifty-one, 
presented with the following history. He had been sent away 
from the city to die or get better from tubercular involvement of 
his lungs. He was running a typical lung temperature, had a 
persistent and very aggravated cough and rales, and these symp- 
toms were aggravated by a definite heart lesion which expressed 
itself in tachycardia with skipping a beat. He was advised 
that he probably would not live over six months when sent to a 
sanitarium in the eastern mountains. After waiting to die for 
about two years and with his condition changing but little, he 
returned to the city and was referred to me by his physician. 
The dental conditions are revealed by the roentgenograms shown 
in Figure 300. It will be seen not only that there was a very great 
quantity of infection in his mouth, but that his reaction had for- 
merly been very considerable to this infection locally, so that 
there were extensive areas of absorption surrounded by zones of 
condensation, indicating a break in that defense. 

As he presented, his weight was 122 pounds; his height, about 
5 feet, 11 inches; a man of large frame but greatly emaciated. 
His cough was very distressing and his heart enlarged, rapid, and 
missing beats. When asked how long he had had this heart irri- 
tation, he stated for several years. This he knew because he had 
been refused life insurance on account of his heart. 

Our program was quite radical. We removed all of the ques- 
tionable teeth. The results were so remarkable that they were 
spectacular. His cough disappeared; his heart irritation disap- 



CHAP. I. XI RESPIRATORY SYSTEM 



115 




Figure 300. Dental infections which produced a condition diagnosed as pulmonary tubercu- 
losis. After their removal the patient gained fifty-four pounds. 

peared; and in a few months' time he had gained from 122 to 176 
pounds. He has since taken out three life insurance policies; and 
it is interesting to note that the insurance companies, knowing of 
his former record, refused to accept the result of his physical exami- 
nation on the ground that it was impossible with the history of 
such a heart lesion as he had had. They wrote to me to find out 
what I had done to make so great a change in his heart. The fact 
that he has taken $50,000 of life insurance, and that he has had no 
recurrence of his trouble in five years, and is carrying on his busi- 
ness, apparently in perfectly normal health, is sufficient evidence 
that his dental infections were the principal cause of both his lung 
and cardiac disturbances. 

Another case is quite as significant though not so spectacular. 
Case No. 1153. — This patient at the age of thirty-eight was 
brought to me by her brother in an invalid carriage a year ago. 
Knowing of his personal experiences, he desired to know whether 
this sister, who was in a hospital with acute lung involvement, 
might not have her condition either aggravated by dental infec- 
tion or be otherwise involved. She had been confined to her bed 
in a hospital for months because of daily temperature, bad cough, 
and raising of sputum, all of which was interpreted as tubercu- 



116 DENTALINFEX riONS& DEGENERATIVE DISEASES CLINICAL VOL.11 

losis of the Lungs, and which may have been true. She, however, 

had occasional symptoms of rheumatism with lameness in the 
neck and shoulders and hips. 

A study of her history reveals that she has had rheumatism 
frequently during her life. Of seven brothers and four sisters, 
one brother and two sisters have had acute rheumatism. Her 
father and his mother had had acute rheumatism. Her mother 
has been until her death recently a bed- and chair-ridden invalid 
for about twenty years with deforming arthritis following acute 
rheumatism. Her mother's father and her brothers and sisters 
have had acute rheumatism. There was. therefore, a marked 
susceptibility to streptococcal infection by inheritance. There 
had also been marked nervous symptoms as neuritis and neuralgia 
in both a brother and her mother. 

Her dental condition is shown in Figure 301 . In the light of our 
experience we would not expect this patient to make an adequate- 
reaction about her dental infections to protect her from the toxins 
and bacteria furnished by them ; and we would also interpret the 
physical conditions in the involved teeth as furnishing a volume 
of infected material, such as should in a normal person produce 
a much greater reaction than is apparent in her case. (See non- 
vital upper left first biscupid. I We, accordingly, condemned the 
upper right first molar, second bicuspid, upper left first bicuspid, 
and first, second, and third molars. The other teeth responded 
normally to testing. 

The result has been most gratifying. She very rapidly gained 
in weight; her cough and fever disappeared; and for the past six 
months, she has been, practically, in perfectly normal health. 
She has gained in weight approximately to her normal, gain ng 
a pound a week for about seventeen weeks. 

In different chapters I have discussed streptococcal infections 
as complications with other disturbances. For example, in a 
study of overloads, I found that in patients suffering from Influ- 
enza, as found in the various city hospitals of Cleveland and 
Columbus at the time of the 1918 epidemic, the incidence of 
serious complications such as pneumonia, heart, empyema, was 
approximately two and one-third times as great in the. groups 
with local dental infection, as it was in the groups without dental 
infection, in which cases the complication was. practically, always 
a streptococcal involvement of the lungs as pneumonia, the pleura 
as empyema, or the circulatory system with carditis. I also found 
many cases of acute neuritis with extensive dental infections. 




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118 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINIC M. VOL. II 

These cases all gave a history of no trouble from their dental in- 
fections either before the attack of Influenza or since its onset. 
These individuals clearly became a prey to an infection already- 
focal in their system, but for which under normal conditions they 
had an ample defense. Similarly, we found in the chapter on 
Pregnancy as an Overload, that a lower defense from that cause 
made individuals and animals susceptible to infections which 
under previous conditions they had carried without apparent 
involvement. 

DENTAL INFECTIONS AND TUBERCULOSIS. 

In the preceding paragraphs I have discussed the relation of 
dental infection to lung involvements simulating pulmonary 
tuberculosis but which are streptococcal lesions or streptococcal 
infections superimposed upon tubercular. There is a phase of the 
relation of dental infection to tuberculosis, which I believe is 
quite new and which has developed from these researches and is 
presented here for the first time. 

In our studies of the physical and clinical histories of many 
hundreds of patients and their families, in my effort to establish 
some fundamental characteristics constituting the presence or 
absence of susceptibility to streptococcal involvements, I have 
included many other susceptibilities for comparison, such as 
susceptibility to typhoid, tuberculosis, influenza, cancer, etc. In 
Chapter 31 of Volume I, I have discussed some phases of the role 
of dental infections in precancerous conditions, and in the chap- 
ter on Overloads, the relation of dental infections to influenza. 
I wish here to discuss my studies on some phases of the relation of 
the presence and absence of susceptibility to streptococcal in- 
fection, to the presence and absence of the susceptibility to tuber- 
cular infection. 

We are all quite familiar with the evidence of an inherited sus- 
ceptibility to tuberculosis as a unit characteristic and similarly 
to an inherited susceptibility to streptococcal infections, as en- 
docarditis and rheumatism, etc. In these studies I have been 
primarily concerned to establish in considerable detail the pres- 
ence or absence of streptococcal susceptibility and the group 
characteristics of each class. In Chapter 1. Volume I. I have 
presented in consolidated form, various data characterizing the 
inheritance and acquirement of streptococcal susceptibility. I 
have not included in the figures presented there, other data which 
was secured at the same time. It early became evident that a 
predisposition to streptococcal infection did not necessarily con- 



CHAP. I. XI RESPIRATORY SYSTEM TUBERCULOSIS 119 

stitute a predisposition to tuberculosis, notwithstanding the fact, 
that dental infections, which are primarily streptococcal, consti- 
tute a distinct overload and handicap in the warfare of the pa- 
tient against tubercular involvements. An analysis of the indi- 
viduals making up the list of those developing tuberculosis, has 
revealed the important fact, that when dividing individuals into 
two groups, those with a distinct susceptibility to periodonto- 
clasia and those without, the former group has much the larger 
percentage of individuals developing tuberculosis. But I have 
said elsewhere and frequently in these chapters that individuals 
with a marked susceptibility to rheumatic group lesions — in 
other words, streptococcal involvements — do not as a group tend 
to develop periodontoclasia, and, conversely, those with marked 
susceptibility to periodontoclasia do not as a group tend readily 
to develop rheumatic group lesions, and when they do so it is 
usually an acquired susceptibility. I have also shown that ten- 
dency to alveolar absorption relates similarly to a physical state, 
whether apical or gingival, and hence and accordingly individuals 
with a high defense for streptococcal infections tend to have the 
more extensive rarefaction about an apical involvement from a 
putrescent pulp or infected tooth structure than do those indi- 
viduals with a distinct streptococcal susceptibility. What I am 
now saying is that those individuals, who, as a group, tend to have 
a high defense for streptococcal infections, are as a group more 
susceptible to tubercular infections. This grouping is not suffi- 
ciently clear cut and constant to make it a universal rule. 

There are several phases of this relationship which have great 
importance, and an understanding of them, when it shall be ob- 
tained, must assist in an understanding of the tubercular infec- 
tion and therefore with developing means for combating it. 
Doubtless all who have had the responsibility of caring for tuber- 
cular patients, have seen all too frequently, the temperature rise, 
perhaps with a bound, following the extraction of an infected 
tooth and, occasionally, seems to mark the development of pro- 
gressive decline, terminating fatally. This type of reaction will 
not infrequently be seen associated with the removal of teeth 
with marked gingival infections rather than periapical. For the 
present, let us think of these individuals as carrying a capacity 
overload, in which state the stirring up of an infected process or 
the liberation of toxic materials will constitute overloads. We 
will also think of these individuals as having a lowered capacity 



120 DENTAL INFE( I IONS& DEGENERA1 IVE DISEASES C LINICAL VOL. II 

lor both defensive reaction and repair. These, however, probably 
do not constitute the whole or chief contributing factors. 

In order further to study these relationships, I have in addi- 
tion to my contact in my clinical practice, endeavored to study 
this problem both by going to sanitariums where various types 
could be seen, and by correspondence. I have made one of thi 
studies at the tubercular sanitarium at the Cleveland City Farm. 
a municipal enterprise for the care of not only the indigent tuber- 
cular patients with well developed or advanced tubercular condi- 
tions, but also for those contact cases, who, because of environ- 
ment and heredity, would be considered susceptible. I wish to 
take this opportunity to express my appreciation of the splendid 
cooperation and assistance of Dr. Rockwood, Director of Public- 
Health, and Dr. Horrigan, Dental Surgeon in charge of oral 
hygiene and oral surgery. I asked Dr. Horrigan what, if any, 
oral or dental pathological lesions he found to be sufficiently fre- 
quently associated with tuberculosis to make it a characteristic 
lesion, to which he replied in substance, a predisposition to gingi- 
val infections and alveolar recessions. 

A study of the patients from bed to bed, while revealing a 
majority with periodontoclasia, disclosed several without this 
lesion in a marked degree. A more careful examination dis- 
closed, however, that some of these individuals had been very 
faithful in prophylactic procedure. In a comparative study of 
periodontoclasia and dental caries in Chapters 7 and 8, it was 
demonstrated that individuals with a marked susceptibility to 
periodontoclasia had a less susceptibility to dental caries. It 
was accordingly of much interest to note that in the individuals 
herewith studied, the percentage with all of the teeth intact, or 
only one or two fillings or cavities in the entire denture, was 
large, which is quite the opposite characteristic of the group 
with a marked susceptibility to rheumatic group lesions. 

If conditions obtain, as these data suggest, (the evidence avail- 
able is not adequate yet for making extended conclusions several 
important questions are suggested, one of which is: 'What are the 
constitutional qualities involved in a defense for streptococcal 
infection and a lessened defense or susceptibility to tubercular 
infection? I have shown in other chapters that there is a dis- 
tinct relationship between the degenerative inflammatory re- 
actions, with the taking down of organized bone as in osteomal- 
acia and periodontoclasia on one hand, and proliferative deform- 



CHAP. LX1 RESPIRATORY SYSTEM TUBERCULOSIS 121 

ing arthritis and calcification processes on the ether. This im- 
mediately suggests that those individuals in which osteoclastic 
activities are dominant over osteoblastic activities, there would 
be a distinct difference in the capacity for calcification of fibro- 
cytic tissues. In ether words, if two individuals, one represent- 
ing each of these two groups, would be considered as having a 
lung tubercle, the data presented in many of these chapters 
would suggest, if not justify, the conclusion that the individual 
with the marked tendency to periodontoclasia and such osteo- 
clastic processes, would in a very much lesser degree calcify the 
tubercle and fibrccytic capsule than would the individual of the 
other grcup with a marked tendency to osteoblastic activity. 
If this line of reasoning should be based on fact, it should be 
possible to find data in a chemical analysis of the blood of tuber- 
cular patients that would throw light upon this process. In 
Chapter 20 of Volume I, I have shown in the first chart a series of 
one hundred successive blood analyses related to both the phy- 
sical condition of the individuals and the type of dental pathol- 
ogy existing. In that and succeeding chapters, particularly 43 
and 44, I have shown a direct relationship between the ionic 
calcium of the blood and the factors of defense and suscepti- 
bility. These have shown that a lowered ionic calcium of the 
blood tends to accompany a proliferative arthritic reaction and 
an exalted ionic calcium tends to accompany, if not produce, a 
degenerative type with osteoclastic tendencies predominating. 
To illustrate, patients with active periodontoclasia practically 
always have an exalted ionic calcium of the blood as do patients 
with osteomalacia. However, individuals with either of these 
(though the latter can scarcely exist without the former) may 
develop in a few months' time a quite divergent physical state, 
in which the gingival pockets would not have been obliterated 
or conspicuously changed, and therefore lead to gross misinter- 
pretation through not distinguishing between an active and a 
passive process. I have not been able to find in the literature, 
data showing in comparison the ionic calcium of the blood of 
individuals making a successful warfare against the tubercular 
parasite, with the ionic calcium of the blood of these making an 
unsuccessful warfare. 

Another factor entering directly into this phase of the problem 
has to do with the acid-base balance of the individual making a 
defensive reaction. I find in the literature, data calling attention 



122 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 

to the fact, that in the terminal stages of tuberculosis severe de- 
crees of acidosis have been noted. My studies tc date do not 
include a large enough number of determinations to warrant con- 
clusions; they do indicate, however, that these individuals in the 
early stages of their tuberculosis tend to have an ionic calcium 
of the blood at and above normal, and an alkalinity index below 
normal. The following are some typical analyses, and it will be 
noted that, in general, they correspond with those of advanced 
stages of periodontoclasia. 

Case No. 1427. Blood from vein. 3 P. M. 

Alkalinity index 25.90 

Calcium plus thrombin 23.00 

Calcium ionic 8.46 

Calcium ionic plus combined 11. 976 

Calcium in combination 3 . 516 

Thrombin content 14 . 54 

Non-protein-nitrogen 41.40 

Blood sugar 84.00 

Uric acid 2.00 

Case No. 1428. Blood from vein. 3 P. M. 

Alkalinity index 24.20 

Calcium plus thrombin 25 . 00 

Calcium ionic 9.943 

Calcium ionic plus combined 12 . 162 

Calcium in combination 2.219 

Thrombin content 16 . 057 

Non-protein-nitrogen 34 . 00 

Blood sugar 78.00 

Uric acid 2 . 05 

Note: These are advanced stages of tuberculosis and therefore 
the ionic calcium has gone down, but the pathologically com- 
bined is very high in both, making the total calcium seem high: 
namely. 11.9 in the first Case 1427 and 12.1 in the second Case 
1 128. The most striking pathological condition is seen in the 
alkalinity index, amounting to a severe acidosis, 25.90 in Case 
1127 and 24.20 in Case 1428. 

By analogy we may be justified in making some observations. 
Since active periodontoclasia reactions tend to develop an ex- 
aggeration of the associating complications, such as acidosis, 
osteomalacia, and pancreatic insulin insufficiency, all of which 



CHAP. I. XI RESPIRATORY SYSTEM TUBERCULOSIS 123 

conditions are lessened in severity and often markedly so by the 
correction of the periodontal infection, it should be expected 
that the development of periodontoclasia might aggravate tuber- 
cular infection by lessening the defense against it, and this is not 
without support from clinical observation, for we have noted a 
direct improvement in many cases by the instituting of adequate 
prophylactic and therapeutic procedures. These should, how- 
ever, be considered as imperative accompaniments with the pro- 
tective and preventive procedures of the early stages, rather than 
means for restoring a defensive mechanism after it is over- 
whelmed and broken. Maver and Wells 2 have shown that calci- 
fications tend to develop and calcium tends to enter tubercles 
even in the early stages of necrosis. Their experiments on 
guinea-pigs indicated "that tuberculous organs regularly show 
much more calcium than normal lesions." 

If, as seems indicated, defense and susceptibility are factors 
which are closely related to calcium metabolism, whether for the 
streptococcal group of organisms or the tubercle bacillus, and if 
it be true that that physical state which tends to the development 
of periodontoclasia and odontoclastic reactions, predisposes to 
tuberculosis, we may have here a new approach to the study of 
the etiology and pathology of tubercular processes, and thereby 
to new means for combating this malady which is man's greatest 
single scourge. 

In the extensive analyses of case histories in connection with 
dental and general pathology in Chapter 4 of Volume One I have 
shown that certain affections tend to group in certain individuals. 
In the subsequent chapters, especially 20, I have shown evidence 
of a chemical basis for these groupings, or at least a parallel 
group of associated serological conditions. If my above sugges- 
tion be true that there is an association between lowered defense 
for tubercular infection and a tendency for osteoclastic activity 
with decalcification processes, as in periodontoclasia, through 
calcification and decalcification activities, it should be possible 
for other associations to be made of tubercular susceptibles. I 
have shown, for example, that individuals with definite tendency 
to periodontoclasia do not tend to have the rheumatic group 
lesions while in that physical state. This has suggested observing 
the association of rheumatic group lesions with tuberculosis, 
since tuberculosis tends to be less successfully resisted by indi- 
viduals with a marked susceptibility to periodontoclasia. I am 
gathering data on this point which will be presented in further 

- See Bibliography. 



124 l>l. VI \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

detail later, but it is important that in about two hundred cs 
now studied in this regard, it has been found that a very large 
majority of the progressive cases support this interpretation. 
I have shown that, in general, individuals with an acquired sus- 
ceptibility, that is a broken defense from overload plus infection, 
behave very similarly to those with an inherited susceptibility; 
and hence a history of rheumatism or other rheumatic group 
lesion would not necessarily contraindicate the above interpreta- 
tion since individuals may change from their normal type of 
reaction during such a break. In checking this factor it will be 
necessary, therefore, to make this observation. The apparent 
exceptions may prove to be those with a broken streptococcal 
defense due to overload. The evidence to dale strongly indicates 
a definite relation between normal osteoblastic activity, or calcium 
deposition, on the part of those with high defense for tuberculosis, 
and osteoclastic activity, or calcium depletion or suspension, on the 
part of those with a low power for fighting a tubercular infection. 
If this be true, we should expect that cases progressing favorably 
would show more extensive calcifications of lung tulx rcles than those 
progressing unfavorably, which, according to many observers, corre- 
sponds with the basis roentgenograph^ observations. 

STREPTOCOCCAL PNEI MONIA. 

With regard to the streptococcal pneumonias, there are two 
types in particular of frequent occurrence. One of these is re- 
lated to influenza in patients carrying streptococcal foci of infec- 
tion. Since dental infections are practically always strepto- 
coccal, this is a matter of great importance. In Chapter 21 on 
Overloads, I have shown that patients suffering from influenza 
tend more definitely to develop complications if they have dental 
infections than if they do not. To review that research briefly, 
I found by examining patients in five hospitals during two severe 
Flu epidemics, that the percentage of individuals having serious 
complications in the group of individuals without dental infec- 
tion was 'SI, and in the group with fecal dental infections it in- 
creased to 7'2. which is two and one-half times the percentage in 
the first group. This strongly suggested that dental infections 
may be carried by the patient without apparent injury while 
that patient has his normal defensive mechanisms. Influenza 



CHAP. LX1 RESPIRATORS SYSTEM— STREPTOCOCCAL PNE1 MONIA 125 

infection, however, destroys the normal defense in a very few- 
hours after its onset, which is shown in the blood morphology 
and blood chemistry. In this state of broken defense the indi- 
vidual becomes a prey to that infection for which he previously 
had an adequate protecting mechanism. 

In Chapter 41 of Volume One I have shown that the defense of 
the blood is very largely dependent upon bactericidins which are 
carried by the leucocytes, and which substances are set free from 
the leucocytes by the antigen of the invading infection. In the 
individual with his normal defense the reaction is so efficient that 
the organisms are destroyed almost immediately that they pass 
beyond their protection within the infected tooth, and that this 
battleground of the first line defense about the apex of the tooth 
constitutes a local quarantine station. Structurally, the tissue 
is highly vascular and designed particularly to combat and neu- 
tralize the toxic substances and destroy the bacteria. The lym- 
phatic circulation carries away a large part of the overflow from 
the chemical processes of neutralization. If the quantity to be 
carried away is too great, a fistula forms to the surface and there 
may be a continuous discharge of the neutralized products. Con- 
trary to the general conception, such a fistula discharges a sub- 
stance which is harmless compared with the toxins before they 
are neutralized. It is not uncommon to see these fistulse close 
with the onset of disease, such as influenza and other fevers, in 
which state the products are not being properly neutralized, there 
is not so much of the overflow of waste product, and instead of 
the battle being a fight to the finish close by the tooth, these 
products may then go to other parts of the body. This is ap- 
proximately what happens in a case of influenza when a patient 
is carrying a dental infection. That warfare, which formerly 
was waged with the complete destruction of invading organisms 
and toxin in the immediate vicinity of the source — namely, the 
infected tooth — becomes much less active and efficient, with the 
result that these products pass beyond that first zone. That 
patient's body has suddenly become like a village without its fire 
department, all right so long as there was no fire, but in the 
presence of a conflagration and high wind the hamlet is doomed. 

In order to determine the effect of dental infections when super- 
imposed upon influenza infection, I have made studies during two 



126 DENTAL INFECTIONS &DEGENERA1 l\i. DISEASES C LINICAL— VOL.11 

epidemics by inoculating animals with influenza virus by using 

the washings from the nasopharynxes of patients during the 
first twelve hours of an attack, and injecting this material into 
the tracheae of the rabbits. This produces a typical disturbance, 
characterized by a change in blood morphology, lassitude, and 
an acute congestion of the lungs, with some emphysema, which, 
however, is practically never fatal. Using the method suggested 
by Olitsky and Gates', I have macerated the lung of such a rab- 
bit and inoculated other rabbits. Those workers have shown 
that an extended series of animals may be inoculated in succes- 
sion by this method and have the typical influenza lesions pro- 
duced by this process of animal passage. By taking cultures 
from infected teeth and inoculating a small amount of a strepto- 
coccal strain into the ear vein of a rabbit carrying influenza in- 
fection, there is a very marked tendency to the development of 
terminal streptococcal pneumonia. This is illustrated in Figure 
303, in which A shows an influenza lung, which is not fatal to 
rabbits, and B the lung of a rabbit dying with pneumonia by 
superimposing a small quantity of dental infection upon the 
influenza. 

It is common knowledge that a very large percentage of the 
deaths from influenza are streptococcal pneumonias. Since so 
many individuals carry streptococcal focal infection about the 
teeth, these individuals are living in the presence of a real danger 
since they cannot know when their influenza attack may come. 
It is, therefore, a matter of very great importance in connection 
with the degenerative diseases, which constitute so large a part 
of the fatalities of a modern civilization which has rid itself of 
the infectious fevers, to see to it that focal dental infections are 
not permitted to develop or remain. If space permitted, it would 
be of interest to present here, data from the reports from the 
various army camps at the time of the outbreak of the epidemic 
of 1918, which not only showed a very high percentage of fatal- 
ities being caused by pneumonia, but also that they were strep- 
tococcal. We must therefore think of these as being blood-born 
rather than air-born with the influenza virus. 

There is another group of pneumonias which have direct rela- 
tion to oral infections, and these are the result of the aspiration 
into the lung of infected material from the mouth. This will 
involve, particularly, cases of advanced pyorrhetic infection, in 
which case there is much streptococcal infection with the spiro- 

■ bibliography 




^r 




Figure 303. Streptococcal pneumonia. Upper view— lungs of rabbit with influenza, 
not fatal to rabbits. lower view — lungs of rabbit with influenza plus inoculatk n 
with small amount of dental culture, causing death from pneumonia. 

127 



128 DENTALINFEX HONS& DEGENERATIVE DISEASES CLINIC \I. VOL. II 

chete, which readily infects the emphysematous exudate in those 
individuals with the lower defense due to influenza or other 
causes. The very nature of the influenza involvement invites 
this result. The development of the frothy exudate in the alveoli 
of the lungs tends to produce violent spasms of coughing, which 
fail to raise this frothy exudate. A violent expiration compels a 
violent inspiration, with the result that oral and nasal mucous, 
with the infections they are carrying, are sucked into the lungs. 
For this reason influenza patients should have their mouths 
thoroughly cleansed and as free as possible from infection. Since 
this process develops suddenly, the only safety lies in the main- 
tenance of a continually clean mouth. This also relates to those 
individuals who for any reason are given a general anesthetic. 
It is my personal judgment that many of the complications of 
pneumonia are nothing more or less than the inspiration into the 
lungs of infected material from the mouth. 

There are the individuals of another group, however, who are 
very susceptible to streptococcal pneumonia, and these are the 
individuals suffering from either deforming arthritis or other 
forms of chronic streptococcal infection. It is probable that in 
these cases their pneumonias are produced in part by the focal 
infections throughout their body, particularly in the joints. In 
several instances where I have cultured the sputum of this type 
of pneumonia, it has proven to be streptococcal in pure culture. 
These individuals, besides furnishing probably many feci for 
streptococcal culture, are generally in a state of low defense for 
that organism, which susceptibility makes them an easy prey. 
The evidence suggests, however, that the walled-off infections in 
passive arthritic joints are not nearly so potential for harm as 
are focal infections about the teeth. Chapter 40 on the effects 
on the teeth of arthritic processes, strongly indicates that these 
individuals tend readily to have the arthritic involvement attack 
the teeth as it does other joints of the body, and I say other 
joints, since the tooth has its attachment by a membrane which 
gives it movement and which mechanism constitutes a joint. I 
have also shown that they tend readily to have calcifications 
within dental pulps. This process tends to produce the death of 
the tooth, in which case its degenerated pulp tissue becomes a 
pabulum for the blood stream streptococcal infection and a new 
focus is thereby readily established. In that chapter I show six 
teeth in succession that have become involved and the pulps 



CHAP. I. XI RESPIRATORY SYSTEM STREPTOCOCCAL PNEUMONIA 129 

non-vital as a part of the arthritic process, quite independently 
of caries or ordinary processes of pulp involvement. Such teeth 
can, therefore, readily become the focus of an active streptococcal 
invasion, producing in a patient a pneumonia, during such period 
as the resistance is lowered. These patients from their moribund 
condition tend to invite respiratory involvements, which condi- 
tion is probably aggravated by the fact that they tend almost 
universally to have a subnormal temperature, to be hypersen- 
sitive to cold, and tend to have their sleeping rooms too warm for 
the best efficiency of the respiratory tract. 

For several years I have been observing my patients with 
deforming arthritis and other phases of acute rheumatic group 
lesions. They have particularly tended to develop pneumonia 
which, apparently, seldom with them proves fatal. In some 
instances I have secured cultures of the sputum raised from these 
patients and have found it to be, practically, pure streptococcal 
culture. My attention was drawn to this condition by the fact 
that in our experimental animals some strains of dental cultures, 
which were always streptococal, though occasionally carrying 
associated organisms, developed pneumonia which was often 
terminal, though in many cases it was found at necropsy as a 
complication, the animals having been chloroformed for examina- 
tion. In practically every instance these lung involvements, as 
pneumonias and empyemas, were streptococcal and culturally 
corresponded to the organism which we had injected of dental 
origin. 

One of the patients above referred to has been bedridden for 
years and almost every joint of her body seems rigid and de- 
formed. She has had three severe attacks of pneumonia. At the 
time the sputum was taken for culture, I found her temperature 
103, pulse 140, respiration 40; one lung apparently entirely con- 
solidated, the other partially so. 

These individuals seem to have evidences of a streptococcal 
susceptibility in that their rheumatic group lesions are strepto- 
coccal, their complications tend to be streptococcal, and, fre- 
quently, cultures made from their saliva and detritus from their 
mouths will grow out pure or nearly pure streptococcal cultures 
in broth media in contrast to cultures taken similarly from 
other types of constitutions. 

In connection with the pneumonias I have referred to the fact, 
in the chapter on Tooth Implantations, that we find a marked 
tendency in our rabbits with teeth implanted to die of pneumonia. 



130 DENTALINFEC fIONS& DEGENERATIVE DISEASES CLINICAL VOL.11 






* >» 




FlGl k! 304. A I'M I MONK II NG WITH STREPTOCOCX \1 PNEUMONIA FROM T11K 
IMPLANTING 'I VN INI EC III' TOOTH BENEATH THE SKIN, SHOWN ALSO IN POSITION IN 

Till-- I Id Kl . 

In Figure 301 will be seen the photograph of a posted rabbit. 
which shows the tooth in position beneath the skin where it has 
become partially encapsulated. The chest wall has been cut 
away to expose the lung. The dark area, which is shown leaning 
oxer the piece of white paper, is consolidated and gangrenous. 
This rabbit died in eighteen days after the placing of the tooth 
under its skin. The most significant feature, however, of these 



CHAP. LX1 RESPIRATORY SYSTEM— HEAD COLDS 131 





w ' ■ 




■"'*«<* fe> 1 


\\ 1 kl 




1 ** l* \V 











Figure 30o. Roentgenographic appearance of the teeth producing a sensitization reaction as acute 
recurring colds. note extensive absorptions of both teeth and bone. 

pneumonias is the fact, that, on culture they show a streptococcus 
in diploid and chain forms, which is characteristic of a type of 
pneumonia that develops in patients with marked streptococcal 
susceptibility, such as those with deforming arthritis. 

HEAD COLDS. 

Under this heading I will discuss a group of disturbances which 
includes sensitization reactions in the mucous membranes of the 
air passages and sinus involvements. The characteristics of the 
former have been discussed in detail in Chapter 30 on Anaphylaxis 
and Sensitizations. I have found that sensitizations tend to 
appear in individuals who, normally, have a high defense and 
with it a considerable quantity of dental infection extending over 
a long period of time. Their good reacting power takes on the 
form or modification of a highly developed sensitization in some 
particular tissues of their bodies. These special tissues are prob- 
ably most frequently (1) skin reactions, (2) mucous membrane 
reactions of the air passages, (3) asthmas, and (4) special organs 



][V2 DENTAL INFECTIONS & DEGENERATIVE DISEASES C LINICAL VOL.11 

and tissues. I will discuss only the second and third of these 
in this connection, because the chief symptom tends to be an 
involvement of the respiratory system. 

In C hapter 30 on Sensitization I have used as an illustration 
an extreme case which should be referred to at this time. 
This man had suffered from these acute inflammatory high fever- 
like disturbances with increasing frequency for several years, 
apparently regardless of season or geographic location. The 
removal of his dental infections has entirely relieved for one and 
a half years these acute symptoms though they had been present 
once or twice a month prior to that time, and the first disturbance 
of his dental infection brought on, within a few hours, the most 
severe attack he had ever had. With the description of this case 
we have illustrated the use of the sensitization test for identifying 
this type of case. 

Another typical and striking case, though not so spectacular, 
is the following : The patient about forty years of age had recur- 
ring colds, as he explained them, every few months or weeks, 
winter and summer, and without apparent cause which he could 
discover. Figure 305 shows his dental infections which were char- 
acterized by an exceptionally extensive absorption of the roots of 
his teeth, a condition which, as we have shown, obtains only in 
certain types of systemic condition and usually those of very high 
defense. This man had never suffered from rheumatism, heart, 
or kidney involvement, cr any of the rheumatic group lesions, 
also characteristic, as I have shown, of individuals with sensitiza- 
tion processes. It will be noted not only that the lower molar roots 
are absorbed but also the upper molar. I have elsewhere, in 
Chapter 1, used this case to illustrate the inability of the Roent- 
gen-rays to reveal conditions as they are. With the removal of 
these dental infections, this patient's tendency to head colds 
entirely disappeared and for two years has not returned. 

ASTHMA. 

Asthma is now recognized as being frequently, if not generally. 
a sensitization reaction to an antigen which varies through a wide 
variety of proteins or albumins. They may be foods, vegetable 
products, or bacterial toxins from focal infections. A typical 
illustration of the latter is as follows: 

A patient of good physique and habits suffered from recurring 
attacks of asthma. On questioning him. I found that these 
asthmatic attacks had a history of development since the history 



CHAP. LX1 RESPIRATORS SYSTEM ASTHMA 133 

of the beginning of his dental infections, that on different occa- 
sions he had had prostrating attacks following a sense of soreness 
and pain about the crowned teeth. He had several bad dental 
infections. They were particularly bad because there was the 
quantity of infection of the pulp chambers of very poorly filled 
roots of teeth that were crowned, and which did not have fistulse. 
With the removal of these dental infections his asthmatic attacks 
entirely disappeared. He had, however, a long history of carditis 
and finally died of heart involvement. 

The types of cases which we have been discussing in this 
chapter will only be found where the dentist or physician has 
taken pains to go carefully into the history and intelligently relate 
the clinical symptoms with the types of dental pathology which 
are present, and by use of sensitization tests such as we have 
described in Chapter 30. 

There is a phase of involvement of the respiratory tract which 
is very confusing and obscure and should be stressed because it is 
of quite frequent occurrence. Patients running a typical after- 
noon temperature with much loss of weight will, in general, sug- 
gest to the internist a possibility of tubercular involvement. 
This will only need the presence of a typical rale to complete the 
diagnosis in many instances. We have referred to such a condi- 
tion with involvement of the heart in this chapter. The rheu- 
matic group lesions do not, in general, tend to be associated, as we 
have shown, with the type of oral infection such as is present in 
typical periodontoclasia, pyorrhea alveolaris. It is, however, a 
very important, and when it is understood will be a significant 
fact, that tuberculosis tends to develop in individuals who have 
had a marked predisposition to periodontoclasia. In another 
chapter we have discussed this relationship. The typical spiro- 
chete infections do not tend to develop in root-end abscesses 
unless that chamber is connected through a liberal opening with 
the mouth, and particularly an opening beside or between the 
teeth but following the cemental wall. In mouths with typical 
periodontoclasia pockets, apical abscesses tend to develop spiro- 
chete involvements when related to the mouth as suggested. It 
sometimes occurs that one tooth may have a very abundant infec- 
tion and not be accompanied by other involvements in the same 
mouth. This involvement may be so located that an ordinary 
examination of the mouth will not disclose such a seriously 
involved tooth. Such a condition may exist and produce very 



L34 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

serious harm and with symptoms quite different from the typical 
rheumatic group lesions. Such a case is illustrated in the follow- 
ing: 

Case No. 1120. The patient presented with so serious a bilat- 
eral sacro-iliac involvement that she virtually had to be carried. 
She had not been able to roll over in bed for many weeks, had 
suffered very severely, and in addition to the neuritis was running 
a daily temperature with cough and rales. She also had a heart 
involvement as a murmur diagnosed as mitral disease. 

An ordinary examination of her mouth revealed an apparently 
well kept mouth with excellent teeth and no evidence to suggest 
that they could possibly be related to her general condition. Had 
not the physician who sent her been a man of very unusual keen- 
ness and thoroughness he would not have suspected the teeth as 
a possible contributing factor. The roentgenogram of her teeth 
shown in Figure 302 showed the lower left second molar to have a 
very deep pocket between it and the third molar, which was dis- 
placed backward, and the pulp of the second molar was non-vital 
and putrescent, the cause for which could not be accounted for 
except by an extension of a distal suppurative periodontoclasia 
which extended to and involved the apices of the roots. There 
were no local symptoms about the tooth to cause the patient to 
have any suspicion of it. The culture was a most profuse spiro- 
chete and streptococcal involvement. With removal of this tooth 
the daily temperature ceased, the neuritis entirely disappeared 
and has not returned, which is now about two years. The patient 
advises that she has never in her life been in better health, does 
all her housework, and most important, the lung symptoms have 
entirely disappeared. In this instance but one tooth was in- 
volved, and while it was seriously so from the standpoint of its 
effect, there were no symptoms locally known to the patient and no 
suggestion from the appearance about the tooth to indicate any 
involvement . The physician or dentist, who on general principles 
for lack of efficiency in diagnosis, would condemn several or all of 
such a patient's teeth because one was involved would do a great 
injury as would also those who. judging from the appearance of 
the membranes of the mouth and the appearance of the teeth. 
supported by the patient's judgment regarding them, would 
pronounce the mouth free from all responsibility. 



CHAPTER LXII. 
PRIMARY AND SECONDARY SEX ORGANS. 

DISCUSSION. 

Neither the literature nor the teachings of the medical and 
dental professions have associated acute and chronic infections 
of the primary and secondary sex organs with dental focal infec- 
tions. While the evidence we will herewith submit strongly sug- 
gests such a relationship, it is not clear what these relationships 
are. In some cases it would seem to be quite strongly suggested 
that the dental infection either selects or aggravates lesions of 
the ovaries, tubes, and uterus. In some other cases, as we will 
cite, it would seem that disease in those tissues has produced 
some changes in the system which expresses itself as an elective 
localization quality in the bacteria of the dental focus. Of over 
a thousand rabbits used in the last two years, localizations in 
ovaries, tubes, and uterus have occurred a number of times but in 
only a very few instances where these tissues were not affected in 
the patient from whom the dental infection was taken, and in 
two of those instances the cultures were taken from the teeth of 
male patients who had suffered from gonorrheal or syphilitic 
infection. ^ 

Case No. 1085. — The first case we will cite is that of a young 
unmarried woman twenty years of age, whose distress at the time 
of her menstrual periods was so severe that she was required to go 
to bed for several days, and whose health, both physical and 
mental, was apparently being seriously injured. Her history 
showed that some five years previously she was hit over the left 
ovary when playing golf. This injury was a matter of history 
without evidence of local injury except for a short period. At 
this time she had some infected teeth which she carried for the 
intervening period. Her condition was sufficiently serious so that 
it became necessary for her either to get relief or give up her 
university work. In addition to the menstrual disturbance she 
had an acute nervous disturbance affecting breathing, which 
began about a year previous to the time of her examination, and 
numbness followed by severe pain in the back of the neck which 

135 



136 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 




I'K. i RE 306. ROENTGENOGRAPHIC APPEARANCE 01 
TEETH, A CULTURE PROM WHICH PRODUCED THE 
OVARIAN AM) TUBAL INFECTIONS IN THE NEXT TWO 
FIGURES. 



was worse before her periods. An acute ovarian pain began three 
months before our history was made, at which time the numbness 
ceased. 

At the time of our first operation we removed the upper left 
central and the lower right first molar, which are shown in Figure 
No. 306, with the result that her ovarian disturbance disappeared. 
She gained rapidly in weight with a very marked improvement 
both mentally and physically. Cultures were made from these 
first extracted teeth and inoculated into rabbits. Six rabbits 
were inoculated, four females and two males. All of the females 
developed acute infection in ovaries and tubes. The males re- 
mained negative. These are shown in Figures 307 and 308, and 
all reveal very highly congested ovaries and fallopian tubes. 
( )\ving to the fact that her university work in another city made it 
difficult for her to be absent long enough to have the other upper 
central incisor removed and replaced, it was not extracted at this 
time, but instead had the old root filling removed, the tooth 
sterilized, and the root refilled and an apicoectomy made. Her 
condition remained greatly improved for a few months when her 
old conditions returned, at which time we removed the central 
incisor, made cultures from it. and inoculated three other female 
rabbits, two of which showed acute infections of the ovaries and 
tubes. 

The result of this operation has been to make so great a change 
in her health that her mother states that she is like an entirely 




Figure 307. Acute ovarian infections produced in rabbits inoculated with cultures 
from teeth of patients suffering from same. 



137 




Figuri 308 Other ovarian [nvolvements in rabbits from sami culture. 
Casi No 1085. 



CHAP. I. XII PRIMARY AND SECONDARY SEX ORGANS 139 

different person both mentally and physically. Her periods are 
normal and without pain. She has gained considerably in weight 
(over twenty pounds) and for approximately two years there has 
been no tendency to a return of her old trouble. It would seem, 
in the light of our study, that we have in this case an elective 
affinity developed in the organisms for ovarian tissue. That the 
organisms from the dental infection were selecting and irritating 
her ovaries seems very probable, if not quite certain; and that 
they are better, if not now quite normal, seems quite certain from 
the fact, that in every way her health seems perfectly normal. 
Whether, however, that quality on the part of the organisms was 
primarily due to the presence in her system of diseased ovarian 
tissue which, because of its influence on the culture medium— 
namely, the circulating body fluids — supplied to the organism 
in the dental culture by the system at large, tended to irritate 
that tissue, is not clear though it is strongly suggested in other 
cases. 

For example, a woman of about fifty suffered severely from 
lameness and pain in the back of the neck and shoulders. Cul- 
tures taken from her dental infections, inoculated into rabbits, 
developed ovarian and tubal infection in several. Why this is 
true is difficult to state, particularly since she had been operated 
upon twice for ovarian infection, both ovaries being removed. At 
the time the second ovary was taken, the uterus was removed; 
and notwithstanding, according to her records, the primary sex 
organs were completely removed, the organisms showed this 
elective localization. This would seem to suggest that the normal 
blood plasma and fluids of the body carry defensive elements for 
each of the various organs and tissues of the body, the absence of 
which defensive elements may be an important factor in the 
development of elective localization qualities in the organisms. 
This may be a fundamental part of the quality we previously 
discussed as organ susceptibility, acquired and inherited, par- 
ticularly the latter. The acute inflammatory process in the pre- 
ceding case was accompanied by engorgement of the tubes with a 
serous fluid in which there were few organisms, but the chief 
characteristic was an acute inflammatory process. 

This is quite unlike the process which has developed in some 
other cases in which the inflammation was limited almost com- 
pletely to the ovarian tissue with the formation of ovarian cysts. 
In Figures 309 and 310 are shown several ovarian cysts; one 
(Figure 310) as large as a small hen's egg ; (Figure 309-B) six 




/ 



*N 




Fh.i R] 30 I Si VEH \l n\ \KI \\ CYSTS PRODI CED FROM U'l TORE PROM TEETH OF 
V PATIENT RECENTLY OPERATED FOR OVARIAN CYST, SHOW \ IN "IV \M> CYSTS ON THE 
VAS Dl PERENS FR< M ^\MI Hill RE. 



CHAP. I. XII PRIMARY AND SECONDARY SEX <>P(.\\s 



1 11 




Figure 310. A very large ovarian cyst produced in a rabbit from a dental 

CULTURE. 



small cysts on one ovary ; and ( Figure 309- A ) a cyst on the vas 
deferens. Direct smear and cultures made from the cyst of 
310 showed Gram-positive diplccocci which corresponded mor- 
phologically with those inoculated into the animal from the 
dental infection. So far as we know, this is the first time ovarian 
cyst has been produced experimentally by the cultures from den- 



] 12 DENTAL INFEC I IONS & DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 31 1 Roentgenographk appearance 
op Hi in op Case L224, the culture from 
which produced till- ovarian cyst shown in 
Figi re 300. The patieni had recently been 

OPERATED FOR REMOVAL OF I ARCE OVARIAN CYST. 



t:il infection and, so far as we know, the first suggestion that focal 
infection may be an etiological factor in its production. This is 
further strengthened by the following case. 

Case No. 1224. A married woman, age thirty-one, had been 
operated upon a few months previously for an ovarian cyst, which 
was about the size of a goose egg, and which had been diagnosed 
as the cause of sterility. Cultures made from her dental infection, 
shown in Figure 311, were inoculated into five female rabbits and 
two developed ovarian cysts, shown in Figure 312. Inasmuch as 
cysts are not developed rapidly, the fact that these rabbits were 
posted in from two to four days puts much greater emphasis on 
the results. The rabbit shown with the very large cyst in the 
previous figure was posted thirty-one days after inoculation. 

It has frequently occurred that the development of infections 
of unusual tissues of this type in rabbits has been the first sugges- 
tion that we have had of such a condition in the patient, and the 
fact that the patient had suffered or was suffering from ovarian 
or uterine trouble was only brought out by careful questioning 
after this elective localization had been expressed by the animal 
inoculations. The next case illustrates this, as do several others. 

Case No. 1050. This patient presented with a history of heart 
involvement with rheumatism. After the inoculation of rabbits 
with the culture from her teeth, without thought of sex, the post- 
ing of a female rabbit a few days after its inoculation disclosed 
enormously enlarged tubes with uterine involvement. The pa- 
tient was questioned and she stated that she had deliberately 
falsified when the hist or v was made. She had been suffering from 



CHAP. LXI1 PRIMARY AND SECONDARY SEX ORGANS L43 




Figure 312. The sections of two rabbits showing ovarian cysts produced in from two to four days after 
inoculation with a culture from the teeth of case no. 1224. 



Ill DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL II 



mm 




Figure 313. A very purulent uterine and tubal infection pro- 
duced IN A RABBIT FROM THE DENTAL CULTURE FROM A PATIENT SUFFERING 
FROM A PURULENT UTERINE DISCHARGE WHICH ENTIRELY DISAPPEARED 
AFTER THE REMOVAL OF HER DENTAL INFECTION. 

a purulent uterine discharge for eight months, which her physi- 
cian had feared was malignant. This infection had been the rea- 
son for her physician's sending her to us for dental diagnosis and 
care. With the removal of her dental infections, this uterine dis- 
charge entirely disappeared and has not returned for two \ears 
and a half except at one time, for a few days, when one of the 
scckets from which an overgrown infected root dower right) be- 
came acutely infected with development of a sequestrum, follow- 
ing the extraction. It disappeared promptly with treatment by 
the removal of the sequestrum. She has gained in weight, gone 



CHAP. I Ml PRJMARY AND SEC I >\I>\KY SEX ORG VNS 1 !.> 

back regularly to her work, and her heart is nearly normal. Figure 

313 shows the dissection of a rabbit inoculated with the culture 
from her teeth, which showed very severe infection of the ovaries, 
tubes, and uterus. When we realize that approximately 550 of 
the 1100 rabbits have been females, and of that 550 not 2 per 
cent have developed ovarian infection from a culture which was 
net taken from the tooth of a woman suffering from ovarian and 
uterine involvement, and also that in many instances of women 
suffering from ovarian, tubal, or uterine involvements, percent- 
ages running as high as 100 per cent of the female rabbits develop 
localizations and acute involvements in these tissues, it is very 
suggestive, if not definitely significant. 




i 



Figure 314. A deep indurated ulcer on the inner surface 

OF THE FALLOPIAN TUBE OF THE RABBIT SHOWN IN FIGURE 313. 

In the photograph of this rabbit with uterine, ovarian, and 
tubal involvement, there will be seen greatly enlarged fallopian 
tubes. A photograph of the lining membrane of one of these 
tubes is shown in Figure 314, and there will be distinctly seen an 
ulcer which nearly perforates. The culture aspirated from the 
tubes of this case gave a pure culture of streptococcus growing 
chiefly in diploid form. Frequently, we find, however, that the 
content of these infected tubes, resulting from the inoculation 
into the ear vein of dental cultures, proves to be sterile, notwith- 
standing the extensive involvement of the ovaries and tubes. 

In this connection I wish to illustrate what may be a significant 
condition and which developed in a rabbit. I have referred to the 
fact, that in exceedingly few instances have we had involvements 
of the ovaries, tubes, and uteri of rabbits where the patient from 
whom the dental culture was taken was not a woman suffering 
from such a condition or with a history of such a condition. In 



1 16 DENTAL INFECTIONS&DEGENERATIVE DISEASES C LINICAL VOL. II 




Figure 315. The highly infi amid fai lopian tubes, ovaries, 

AND UTERUS OF A RABBIT INOCU1 \TK!> WITH A CULTURE FROM THE 
TEETH OF A PATIENT WITH SYI'IIH I--. 

Figure 315 will be seen the dissection of a rabbit in which the 
ovaries, tubes, and uterus are very highly inflamed, and en- 
gorged with pus. This rabbit received lour small inoculations of 
the culture from the teeth of a patient with syphilis. We do not 
know whether there is significance in this association. The fact, 
however, that while this type of disturbance is so rare, we have 
had this kind of reaction in cultures taken from the teeth of two 
different men with a history of syphilitic or gonorrheal infection, 
is at least suggestive, if not significant. 

This elective localization of primary and secondary sex organs 
is not limited to females. In approximately 550 male rabbits in 



(.'II \1>. 1.X1I PRIMARY AND SECONDARY SEX ORGANS 1 17 




Figure 316. Acutely inflamed testicles, one from each of three 
rabbits inoculated from the cultures of three different teeth of 
a patient suffering from acute swelling and pain in testicles. 
he had previously had gonorrheal or syphilitic infection. 

the group here reported, infections of the male generative organs 
have occurred rarely. In Figure 316, three testicles are shown 
from three different rabbits inoculated with cultures from three 
different teeth of the same patient. These are more instances 
than had appeared in any hundred male rabbits previously. 
Figure 317 shows the teeth from which these cultures were taken. 
When the patient was questioned, he stated that he had been 
afflicted with a painful swelling of the testicles during recent 
months in conjunction with rheumatic involvement. His rheu- 
matism was completely relieved by the removal of the infected 
teeth and the testicular pain greatly relieved. He acknowledged 
that there had been gonorrheal or syphilitic infection twenty 
years previously. 

It does not follow that the presence of involvement of the 
testicles in conjunction with dental infection is related to gon- 
orrheal or syphilitic infection. In several instances where the 
pain and swelling of the testicles have been a very marked symp- 
tom and have been relieved by the removal of dental infections, 
the evidence has been satisfactorily established that there was 
no previous infection. 

In Chapter 34, on Pregnancy Complications, we have dis- 
cussed researches that we conducted for the purpose of studying 
the influence of dental infections, or the infection from that 
source, on pregnant animals, with reference to illustrations from 
practical cases. In this chapter, I wish to present some striking 
illustrations of the effect of overload in reducing the defense. We 
have stated in Chapter 21 that a very large number of our 



1 IS DENTAL INFEC TIONS& DEGENERATIVE DISEASES i LINICAL VOL. II 




Figure 317. The teeth from which the cultures were taken producing results shown in Figure 316. 








** 




Figure 318. A helpless casting of multiple arthritis. She can scarcely move i joint of her body. 



CHAP. I. XII PRIMARY AND SECONDARY SEX ORGANS L49 

patients suffering from aeute and ehronic rheumatic involve- 
ments have histories which show that this condition dated back 
to pregnancy or lactation. (It is significant that nearly all bed- 
ridden cases are females. ) The following is a striking illustration. 

Case No. 338 The patient, eight years ago, age thirty-five, 
was suffering from very severe acute and chronic deforming 
polyarthritis. When carried to the office, she confided to me that 
she greatly wished to get better because her husband had told her 
that if she did not die or get better soon, he would leave her. Her 
four children had been taken from her and placed in public insti- 
tutions ; and recently, when brought to see her, they were in such 
a condition that she had a burning new desire to get well to get 
her family together again. Her utterly helpless bed-fast crippled 
condition is shown in Figure 318. She was entirely helpless; 
could be lifted into a chair for a little while, but her suffering was 
so great that she had to be moved frequently ; could not feed her- 
self or do anything to wait upon herself. 

With the removal of the dental infections and the use of an 
autogenous vaccine, she very greatly improved, so much so that 
she was able again to feed herself, do the family cooking, and 
her four children were brought back from the institutions in which 
they had been kept, and her family was reunited. She could 
even comb her own hair as well as feed herself. While making 
this progress, the very great misfortune occurred that she became 
pregnant. She soon became bedridden again, for her system 
could not furnish the vitality and new tissues, particularly cal- 
cium, required for the new life. It was, as is so often the case, the 
flame to the smouldering fire. Three of her sisters died of com- 
plications attending childbirth, probably puerperal fever, which 
is a streptococcal infection. She has never since regained the use 
of her joints. The consolidation and ankylosis has gone steadily 
on until she can only quiver her fingers. The child born from 
that pregnancy is now seven years old, and she lives on. She has 
had penumonia three times. On one occasion, I w r ent to her 
home; at the time, it seemed impossible that any person could be 
so ill and survive. Cultures made from the sputum showed a pure 
streptococcal pneumonia. She looks upon her affliction as a 
divine punishment for her pregnancy. In this connection, when 
we see, as I do, so many cases of bedridden complications in the 
form of arthritis, dating back to pregnancy and lactation, it em- 
phasizes the very great need for a campaign of culture and educa- 
tion that will protect women in this most dangerous condition of 
streptococcal susceptibility. 



150 DENTAL INFEC I IONS& DEGENERATIVE DISEASES CLINICAL VOL. II 

Alter this patient's setback and later pneumonia, I had her 
brought in an invalid carriage to my ward to see if we might 
relieve her of some of her acute suffering, for she was again in 
very great distress from acute processes. She was practically as 
immobile as though lifeless, except that she could move her lips 
and her fingers. There was practically no movement in her knees, 
hips, spine, and elbows, and but little in her mandible. During the 
period of three years following her pregnancy, she had progres- 
sively gotten worse, and with this came a necessarily great neglect 
of the mouth. Some additional teeth had become non-vital. These 
were removed with the result that the acute inflammation and 
pain subsided; and she felt that great benefit had been derived 
although the increase of movement was only sufficient to allow her 
to move her arms slightly at the shoulders, permitting a swing of 
about six inches with each arm. Since that time, she has been 
quite free from pain, though she is compelled to lie rigid in every 
joint except her mandible and her fingers, about the only move- 
ments she can make being with her lips, throat, and voice. 

Her history shows that her mother had rheumatism and heart 
involvement, and that her mother's mother died of acute and 
chronic arthritis. Her father was an alcoholic. Her first attack 
of rheumatism came on at twenty-one years of age when she was 
working in a foundry that was not properly heated, and her work 
was polishing the iron fixtures for harnesses which were frosty 
cold. With her rheumatic susceptibility and extreme chilling, 
together with dental infections which dated back to that period, 
she developed these serious lesions. I would like the dental 
readers of this to visualize what their feelings would or should be 
if they could know that even through ignorant conservatism they 
had contributed to such an almost endless living death. 

Another and striking illustration is the following : The patient, 
Case No. 1269, brought by the Visiting Nurse Association, has 
both a central nervous system disturbance and myositic rheuma- 
tism which has made her a bedridden invalid for two years, as 
well as a very severe sufferer. Her history shows that she has had 
six pregnancies in seven years; and two years ago, she had a mis- 
carriage with a two months' pregnancy and was again pregnant 
within a month; and her present acute involvement developed 
during that period, from which she has made almost no progress 
toward recovery. Since writing the above, this bedridden un- 
fortunate who was making very definite improvement and 
progress toward a comfortable condition, has again become 




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151 



L52 IM.Vl VL INFECTIONS & DEGENERATIVE DISEASES CLINICA1 \< L. II 

pregnant, and her condition is very greatly worse than it has ever 
been before. She can now scarcely move any part of her body 
and is continually begging that she may die. She may live for 

\ tars in this almost inconceivably distressing condition. The 
roentgenograms of her teeth are shown in Figure 319. and it will 
be noted, as. for example, in the lower molar, that there is evi- 
dence of a previously high defense which, however, is surrounded 
by a condensing osteitis, which change in structure probably 
relates in time to the overloads and the breaking of her defense. 

These cases may be aggravated also by any infective fevers, such 
as typhoid, diphtheria, etc. The following is a typical illustration. 
The patient was a helpless invalid with deforming arthritis, as 
shown in Figure 320. In addition to her severe arthritic involve- 
ments, she had bed sores as large as half an orange. Her history 
showed that she had been in good health until a pregnane)' which 
occurred at about forty-two years of age, with which she de- 
veloped her acute rheumatism and preceding which, she had had 
considerable acute tooth-ache that received no attention. The 
condition of her mouth was one of apical infections. We re- 
moved her to a hospital where she could get better care and 
where it would be possible for me to carry out the proper program. 
With the removal of her dental infections and the use of a vaccine 
and her better care, she improved so greatly that she was able to 
get up in her wheel-chair, roll herself about, feed herself, and was 
practically without pain. She returned to her home with a vision 
of enjoying again the happiness of her five-year-old little girl and 
of being able to cook once more for her husband. Shortly after 
her return, this little girl came down with diphtheria which her 
mother contracted, with the result that her acute rheumatism 
was again lighted up and she became almost as rigid as previously. 
Could she have been properly protected and properly cared for, 
we believe she might have made much further improvement 
which was progressively occurring up to the time of her contract- 
ing diphtheria. 

These researches show clearly that when society becomes more 
intelligent, motherhood will get u very different protection. I 
have recently been informed by a patient, when getting her family 
history, that her mother, who had lived in Europe, died at thirty- 
four after having given birth to eleven children besides which she 
had two miscarriages. Several of the children of this woman died 
in childhood from symptoms which indicate rickets. 



( II \1\ 1.X1I 



PRIMARY AND SECONDARE SEX ORGANS 



L53 




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15 I DEN I AL INFECTIONS &DEGENERA1 l\ EDISE \SES C LINICAL VOL. II 

We do not know what all is involved in the maternal overload 
of gestation. In the chapter on Overloads I have reported the 
result of our researches on the deficiencies of gestation as indi- 
cated by blood analysis. It is very significant that the ionic cal- 
cium of the blood is often lowered in this condition, as it is also 
in the saliva; and the tendency to dental caries has been shown, in 
the chapter on Caries, to be related directly to this state. 

Dental and medical care of expectant mothers must finally in- 
clude an intelligent estimation of the calcium starvation as well 
as other elements, particularly phosphorus, and it must become a 
part of intelligent living that this condition shall not be allowed 
to occur, where the system has not an ample factor of safety, and 
is free from sources of focal infection against which the body may 
have ample defense during normal stress, but an inadequate de- 
fense during this overload. This is particularly illustrated by the 
effect on rabbits of inoculations with culture producing serious 
streptococcal lesions, from which the rabbits apparently, com- 
pletely recovered after several months' time. But while their 
recovery was adequate to let them return to apparently normal 
health under ordinary stress of life, they were not able to hold 
this walled-off infection in check after the overload of pregnancy 
was established. I will, accordingly, refer for detailed descriptions 
of this to Chapter 21 on Overloads, Figures 140 and 141. 



CHAPTER LXIII. 
KIDNEYS AND RELATED EXCRETORY ORGANS. 

DISCUSSION 
KIDNEY. 

^Whereas, formerly, we looked upon kidney lesions as being 
remotely related to dental infections, we have come to recognize 
a very great responsibility in leaving dental focal infections in the 
mouths of patients having either an acute or chronic nephritis, 
or marked susceptibility by heredity for same. We have fre- 
quently found in patients, in the thirties and forties, that he or 
she was already developing nephritic changes without its having 
been suspected, either by the patient or the family physician, 
and was only looked for by us, because of finding in the suscep- 
tibility study, that it might be expected, that there might be an 
hereditary susceptibility, together with the fact that the patient 
was found to have definite dental focal infections. This would be 
illustrated by the following : 

Case No. 692 — The patient, female, unmarried, age thirty-five, 
had generally been in good health during her lifetime with the ex- 
ception of rheumatism, from which she had been free for several 
years. The susceptibility study, as shown in Figure 321, revealed 
the fact that her father had died of Bright's disease, that the 
father's father and mother had each had Bright's disease, that one 
brother had died of Bright's disease, and one sister had died of 
heart trouble. The urinalysis made for the patient revealed 
albumin and a great abundance of casts, shown in Figure 322. 
Some teeth had been considered border-line until this infor- 
mation was secured; but, on ascertaining this serious condition, 
they were condemned. Three of her teeth, which are shown in 
Figure 322-1, were extracted and implanted beneath the skins 
of three different rabbits, roentgenograms of which are shown in 
two positions in A and B. C shows casts in the urine of a 
rabbit inoculated in this way. D shows the organism recovered 
from the blood stream when posted. F and G show the 
histological appearance of the kidney, revealing acute parenchym- 

155 



L56 DENTAL INFE< HONS & DEGENERATIVE DISEASES CLINIC \l. VOL.11 



Private Records of Weston A. Price, M.S.. D.D.S.. 8926 Euclid Avenue. Cleveland. 


Ohio 






Kl SIS 1 \\(.l \\|) Si 
Patient ; Caa 


SCEF1 1 


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l'n.i RE 321. SUSCEPTreiLITY STUDY SHOW tNG MARKED SUSCEPTIBILITY TO KIDNEY LNV01 VEMEN1 
INCLUDING PATIEN1 UMD FOUR MEMBERS OF FATHER'S FAMILY. CASE N 




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aw* 

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Figure 322. Rabbit reactions to tooth implantations of case in previous figure. A 

AND B, IMPLANTED TEETH. C, CAST IN THE RABBIT'S URINE. D, ORGANISMS IN THE RABBIT'S BLOOD. 
E, CASTS IN THE PATIENT'S URINE. F AND G, NEPHRITIC KIDNEY SECTIONS. 

157 



158 DENTAL INFECTIONS ^DEGENERATIVE DISEASES CLINK \I. VOL.11 

atOUS nephritis. All three rabbits, so treated, developed acute 
nephritis. H shows the involved rabbit. It is interesting to 
note that, alter these teeth had been in rabbits' tissues for a 
period of time, they lost their ability to produce nephritis, 
and, at this time, three months after their extraction, thi 
teeth are being carried in rabbits without apparent effect 
upon them. 

It sometimes occurs that, when teeth are implanted, they pro- 
duce quite violent reactions with abundant development of pus, 
and at other times there is exceedingly little reaction about the 
tooth. It does not follow, however, that the former condition is 
necessary in order that serious lesions may develop in animals. In 
the following case (No. 861) the patient, male, age sixty-eight, had 
both sugar and albumin with casts and renal cells in the urine. A 
tooth that had been considered border-line, shown in Figure 323, 




Figure 'A2'A. Tcoth from patient with nephritis. 
See next figure. 



was accordingly condemned, and when extracted was planted 
beneath the skin of a rabbit which was posted in two weeks' time. 
Figure 324 shows the appearance of the tissue about the tooth when 
the rabbit was posted. As will be seen, there was exceedingly 
little local irritation about the tooth; but, notwithstanding this 
fact, the rabbit was losing in weight, and developedan acute nephri- 
tis, as shown by the kidney section in Figure 325. Some of the 
borings of the interior of this tooth, which was apparently well 
root-filled, were inoculated into another rabbit after being ground 
finely enough for them to pass through a hypodermic needle. 
The normal salt suspension of these tooth chips was injected 
beneath the skin of the rabbit. It also developed acute nephritis. 
From these last two cases it will be noted that the quantity of 
infection that was inserted in the rabbit was exceedingly small, 
not a grown mass of culture inoculated into the circulation, and 
the organisms in the tooth placed beneath the skin, or small 



CHAP. I. Mil KIDNEYS AND RELATED EXCRETORY ORGANS KIDNEY L59 









* 



I 

f 



S 





Figure 324. Tooth of previous figure beneath the skin of a rabbit produced 
A slight local reaction but rabbit developed acute nephritis, as shown in next 
figure. 

quantity of the chips drilled from the tooth, had to take the 
chance of being obstructed or annihilated by the various defenses 
of the body, and all tissues had equal opportunity for making a 
defense, so far as other parts of the body were concerned. But 
notwithstanding this, the elective localization quality was suffi- 



' 



160 DENTAL INFECTIONS & DEGENERATIVE Dl CLINICAL VOL.11 











Figure :^.~>. Section of nephritic kidney with pus cej i s. 

ciently strong for these organisms to select the kidney, as shown. 
The total quantity, by weight, of organisms injected with the 
fine borings would be less than a millionth part of a gram, yet 
they were sufficient. This is a fact we have demonstrated in 
many ways many times, and we are stressing it because of the 
misapprehension that the organisms growing in dental infections 
are, of necessity, of such low virulence that the quantity that 
would have to be injected into a man would be from a teacupful 
to several quarts. 

It is very evident that this generation of dentists very much 
prefers to hear evidence that will justify the leaving of root-filled 
teeth and particularly justify the retention of teeth for operative 
procedures, such as crowns, bridges, inlays, etc.. from which there 
could be no further income for the operative dentist after they 
have once been condemned and assigned to the exodontist and 



CHAP.LXII1 KIDNEYS AND RELATED EXCRETORY ORGANS KIDNEY L61 

the prosthetic specialist. I fear another generation of the pro- 
fession, which we must expect will have much greater information 
on these subjects, will find it difficult to distinguish between the 
blindness of ignorance and the blindness of desire. 

Kidney involvements express themselves quite differently from 
different strains. In the two previous cases shown, the hyper- 
trophy of the kidneys was not great. In the next case (No. 573) 
we have that of a married woman, age forty-one years, suffering 
from rheumatism and heart trouble. Incidentally, as a part of 
this study, a urinalysis was made with the result that evidence of 
nephritis was disclosed. Her extracted tooth was cultured and a 
rabbit inoculated in the marginal ear vein with 1 cc. of the 24 
hour culture. In 49 days the rabbit was posted with the result 
shown in Figure 326. D shows the two enormously enlarged 
kidneys of the rabbit, five times their normal weight for the 
weight of the rabbit, and a normal kidney beside them; A and B 
show the histological appearance of the kidney; and C shows a 
cast from the patient's urine. The following is the pathologist's 
interpretation of the sections from this kidney : 

"Inverted Ocular shows a large wedge-shaped piece of tissue 
of a spongy character, stained with a light pink color. The large 
part of the section shows a great number of dilated spaces, re- 
sembling small cysts. Among them one can see the very small, 
shrunken down glomeruli. Most of those dilated, cyst-like 
spaces have a pinkish stained material. 

"Low Power. — The cortical portion of the kidney is represented 
entirely by a great number of dilated tubules and glomeruli, giv- 
ing the picture of a multiple cystic condition. Practically every 
one of the glomeruli is gone; only a small piece of the tuft is left 
and has lost its attachment to the Bowman's capsule. All these 
tubules are markedly dilated, the lining membrane gone, and the 
walls in between the tubules are only of a fibrous tissue. In some 
places some of the tubuli are seen to be compressed among the 
neighboring dilated tubules, their lining also disappearing and 
being represented as small empty vesicles. In some of the 
tubules, large dilated and small compressed, one can see a colloid 
material, in some instances mixed with a few desquamated 
epithelial cells. As one examines the tissue from the cortex down 
toward the medulla, the dilated tubes are larger and larger and in 
many cases two or three have joined together. The tubules in 
the medulla show degenerative changes, vacuolation in the cells 



162 DENTAL INFEC flONS & DEGENERATIVE DISEASES CLINICAL VOL 11 




FlGURB 326 Aim [NTERSTITIAI nephritis produced in a rabbit. A and B, tissue sections showing i Cellu- 

I \K NE< ROSIS Wl> EDEMA. D, BOTH KIDNEYS OF INJE( 111. RABBIT. PIVE TIMES N( KMA1 SIZE Ml NORMAL KIDNE1 
TORK.11T, AISOHYPKKTKOIMIY OF A1HFNALS C, CASTS FROM PATIENT'S URINE. I- IS NO. 5( 

of the lining membranes. In some places many cells show com- 
plete cellular necrosis. The blood vessels are dilated. 

"High Pouh r shows the same changes as above. 

"Diagnosis. Acute interstitial nephritis with marked, acute 
edema of the tubules and glomerular structures of the cortex 
(especially ." 



CHAP. I. XIII KIDNEY S AND RELATED EXCRETORY ORGANS KIDNEY 163 

As this case is not reviewed in the heart cases, we will state that 
the patient's mother and mother's mother, and a brother and 
sister of her mother, all died of heart lesions. This was, accord- 
ingly, a susceptible tissue in this patient. Her lassitude, rheuma- 
tism, and nephritis all cleared up quite promptly and have been 
absent for three years so that she has again taken up her routine 
hard work as an office secretary and is carrying a very heavy 
overload without recurrence of her almost prostrating symptoms 
from which she formerly suffered. Two of the teeth that were 
extracted are shown in Figure 327, and you will note the marked 



Figure 327. Two of the teeth 

OF PREVIOUS CASE PRODUCING 
KIDNEY INVOLVEMENT. NOTE CON- 
DENSING OSTEITIS, NOT RAREFYING. 




tendency to condensing osteitis and the absence of the rarefying 
osteitis so generally looked for. The culture was taken from the 
teeth shown in Figure 327, which was inoculated into the rabbit 
which produced the acute nephritis shown in Figure 326. Figure 
328 shows the susceptibility chart of her case. 

BLADDER. 

Bladder irritations are frequently caused or aggravated by 
dental infections. This will be illustrated by the following case. 
A man of sixty-five was so distressed with cystitis that for five 
years he had been unable to leave his home to visit his family, and 
was required to void his urine from every thirty minutes to one 
hour or his distress would be unbearable. This, of necessity, 
greatly disturbed his rest. A bacterial examination of his urine 
showed an abundant staphylococcal infection. The teeth shown 
in Figure 329 were extracted and his cystitis improved within 
twenty-four hours, and in two weeks' time he was retaining his 
urine for five hours with so complete a relief of his distressing 
symptoms, that he went to New York to visit his son and remained 
several weeks without annovance or discomfort. 



K'.l DENTAL INFEC I IONS* DEGENERA1 IVE DISEASES ( LINIC AL VOL. II 





Private Records of Weston A. Price, M.S.. D.D.S.. 8926 Euclid Avenue, Cleveland, 


Ohio 




r 


RESISTANCE AM) SUSCE 
«"» ir S.AF. N*. J 


PTIBILITY CH/ 

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FlCI Ri 328 SUSCEPTffilLITY OF PREVII US CASE, NO. 573. NOTE I'd K C ^SES OF DEATH FROM 

III \K'I i\\di VEMEN1 ON MOTHER'S Ml 1 . 



Figure 329. Teeth which pro- 
duced ACUTE AND CHRONIC CYSTITIS, 
WHICH PROMPTLY DISAPPEARED AFTER 
THEIR EXTRACTION. 




In our experimental animals we frequently see very marked 
distention of the urinary bladder, following our inoculations, with 
ulcer formation on the bladder wall. Figure 330-B shows a bladder 
approximately twenty times its normal size. Figure 330-A shows 
a large ulcer on the inner surface of this bladder. This rabbit was 
inoculated with the culture of a tooth shown in Chapter 66 on 
the Central Nervous System, and the retention of urine was due 
to a complete paralysis from a lesion of the spine. The patient, 
from whose tooth the culture was taken, was suffering from re- 
curring central nervous system disturbance. This rabbit had 
been affected with incontinence of urine prior to the development 
of retention. This lesion is of particular interest because of the 
recent important work of the surgeon, Dr. Richard Cabot, in which 
he has shown the importance of the prevention of retention of 
urine because of the important role it plays in the production of 
bladder lesions. It is very significant in looking over our records 
that, approximately, three per cent of the rabbits inoculated with 
dental cultures, show gross evidence of cystitis at necropsy. 

The great importance of the susceptibility study and physical 
history of the patient will be shown in a review of Case No. 781. 
The patient, twenty-eight years of age, presented for dental care. 
The only physical disturbance complained of was lameness in her 
back. A roentgenographic study of her teeth did not reveal con- 
ditions that were considered serious. A crowned molar was con- 
sidered border-line. A susceptibility study, shown in Figure 331, 
was made. This and her history revealed that her personal condi- 
tion had been good until her recent disturbance. Her father was 
living, was sixty-three years of age, and has had excellent health 
and freedom from all rheumatic group lesions. His father lived 
to eighty-five. Her mother's record, however, shows that she 

165 



DEN1 M.INIlA PIONS& DEGENERATIVE DISEASES CLINICAL VOL 




I K.I RE 330. PARAl YSISOF Till HI tDDER WITH RETENTION, PRODUCED IN A RABBIT BY DENTA1 [NFECTION. BLAD- 
DER IS rWENTY riMES ITS NORMAL SI2E, VS SHOWN IN B. A SHOWS DEEP I LCEH ON INNER SURFACE OF DISTENDED 

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Figure 331. Susceptibility chart of apparently normal patient. Note eight cases of 

DEATH FROM BRIGHT'S DISEASE ON MOTHER'S SIDE. EXAMINATION OF PATIENT SHOWED SAME 
ACUTELY DEVELOPED, THOUGH UNSUSPECTED, AT AGE TWENTY-EIGHT. 

167 



168 DENl VL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

died at sixty of acute heart involvement and kidney involvement. 

Her mother's lather died of Blight's disease as did three of her 
mother's brothers at about thirty years of age and three of her 
mother's sisters at about that age. In other words, of nine 
children of which her mother was one, seven died and their father 
died either because of, or with. Blight's disease, only two of the 
nine escaping. This strongly suggested that a careful examina- 
tion and study be made of this patient's kidney function. This 
was done and it was found that she already was showing albumin 
and casts. She was accordingly referred to her physician for 
careful observation and treatment and the tooth in question was 
no longer border-line. It was extracted, for our interpretation, 
growing out of our experience, is that no person should be per- 
mitted to carry definite dental infection who has an involvement 
of an organ of which that infection would be likely to increase the 
severity, if that organ is one whose impairment would seriously 
injure or endanger the patient's life or health. In other words, I 
do not consider it safe for a patient having a distinct evidence of 
either heart or kidney involvement, to carry a root-filled tooth, 
because I do not know of any method which has stood the test 
as being competent to make such a tooth completely free from 
infection and source of toxin, and retain it so, and because I feel 
that patients with susceptibility to these affections will, of neces- 
sity, have a low factor of defense immediately about the tooth. 
In other words, they will not have the ability to maintain an 
adequate quarantine against either or both the toxic substances 
developing in the tooth or the bacterial infection from that source, 
if it should develop. I further believe that all root-filled teeth 
sooner or later, and most of them sooner, become infected to some 
extent, if they are not already so at the time of root filling, unless 
that patient has a very high defense and is able to maintain a high 
state of systemic defense and protection of the culture medium 
which develops in even well root-filled teeth from systemic in- 
fection. 

There is a phase of kidney function which should be discussed 
in this connection and is related to a disturbance of the ionic cal- 
cium of the blood as a pathological condition of that fluid. Under 
normal conditions of sugar content of the blood there is an ample 
factor of safety which adequately prevents sugar from appearing 
in the urine. If, however, for such reasons as we shall present, 
sugar does appear in the urine without its elevation beyond the 
threshold of danger in the blood, it does not constitute a diabetes 






CHAP. 1XI1I KIDNEYS& RELATED EXCRETORY ORGANS BLADDER L69 










• 




I 



Figure 332. Hypertrophied kidney and casts from urine of a 
rabbit which developed severe nephritis in sixteen days from the 
implanted tooth shown, well encapsulated. 



L70 DENTAL INFEC riONS& DEGENERATIVE DISEASES CLINIC \L VOL.11 

mellitus. The secreting cells of the glomeruli which normally are 
impervious to the sugar of the blood as it passes through the 
adjoining venules, may become permeable by an increase in the 
ionic calcium of the blood above its normal. It is not yet estab- 
lished to what extent a loss of function of the island of Langerhans 
of the pancreas tends to increase the ionic calcium of the blood. 
It is, however, an apparently associated condition in that, as we 
have shown in other chapters in our study of the relation of 
periodontoclasia to diabetes, the ionic calcium of the blood is, 
practically, always high and tends to be pathologically so in both 
these conditions. We have then the suggested possibility, if not 
a probability, that disturbed kidney function through the medium 
of disturbed ionic calcium of blood may be directly related to 
periodontoclasia or pyorrhea alveolaris. 

I have now had so many instances where rabbits developed 
acute nephritis from each of the procedures, the inoculation of 
cultures and the planting of teeth from patients with and without 
nephritis, but particularly so in patients with nephritis, that I 
find no way of escaping the placing of the responsibility of a great 
many of the kidney disturbances on this source. In Figure 332 
will be seen the dissection of a rabbit which had a bicuspid tooth 
planted beneath the skin. It died in sixteen days with a loss of 
310 grams, or approximately 25 per cent of its weight. On open- 
ing up the skin there was an encapsulated subcutaneous abscess 
about the tooth, a smear from which showed Gram-positive 
streptococci in individual forms and small chains, and also some 
Gram-negative organisms. The heart showed hyperemia of the 
myocardium, with ulceration of the aortic arch. The kidneys 
showed parenchymatous nephritis. The urine showed casts. 
In the illustration of this case, the encapsulated tooth is shown, 
and also the hypertrophied kidney and casts from the urine of 
this rabbit. 

In Figure 333 will be seen a cast from the urine of a rabbit dy- 
ing with kidney involvement from the planting of a tooth in two 
days after the planting of the tooth. I Rabbit 1144. 1 It is prob- 
able that any infection that will sufficiently overwhelm an animal 
or individual and produce death will, at death, so overload the 
kidney as to produce marked disturbance of function, and it must 
not be considered that the presence of casts will, of themselves, 
be an indication or proof of an acute or chronic nephritis. Their 
presence, however, is distinct ly pathognomonic and. as such, 
have very clear significance. 



CHAP. l.XIII KIDNEYS& RELATED EXCRETORY ORGANS BLADDER 171 




Figure 333. Casts from urine of a rabbit 
dying in two days with kidney involvement, 
from the planting of an infected tooth beneath 

THE SKIN. 



CHAPTER LXIV. 
SKELETAL AND MUSCI LAR SYSTEM. 

DISC USSION. 

It is exceedingly difficult, in the present state of cur knowledge, 
to differentiate between lesions of the nervous and muscular 
systems, and it seems wry probable that frequently both are in- 
volved in the same case. We shall, however, endeavor to adhere 
to cur classificaticn according to the biological classification of 
tissues. We will, accordingly, present the cases under the sub- 
classifications of (1) acute rheumatism, (2) deforming arthritis, 
(3) synovitis, (4) csteomyelitis, and (5) myelitis. 

It is not clear, as yet, to what extent the reactions are to toxins 
or to bacterial invasion. I will show cases in which I have secured 
the culture from the myesitis of both the patients and the rabbits 
and show them in situ in sections of the tissues from both sources. 
The evidence is, therefore, convincing to me that the organisms do 
localize in the muscles in certain cases. This is not only true of 
muscles but of synovial membranes, for we have on scores of 
occasions located the same strain, which we have inoculated, by 
culturing from involved joints. A typical illustration of such is 
shown in Figure 334. I have shown in the experimental chapters 
of Part One, that these inflammatory processes very frequently 
have their first expression as zones of local ischemia, and the evi- 
dence is accumulating to emphasize the possibility, if not prob- 
ability, of many cf these localizations beginning as sensitization 
processes. In patients carrying fecal infections, the presence of 
the toxic substance from these zones produces anaphylactic re- 
actions. Such tissues, as in that patient, readily develop or oc- 
clude the antibody which combines with the antigen, thereby 
producing locally the various phases of sensitization reaction, 
one of the first of which is the marked and rapid relaxation or en- 
largement of the capillaries. This is followed by a rapid accumu- 
lation of leucocytes about the zone receiving the acute hyperemia. 
This may be followed by localized stagnation sufficient to develop 
degeneration or even necrosis of cells. The antigen producing 
this reaction may. I believe, be the toxic substance from the focal 

172 



CHAP. I.XIY SKELETAL AND MUSCULAR SYSTEM L73 







Figure 334. Typical illustration of streptococci and diplococci 
in joint fluids of animals inoculated with a dental culture. 

infection without the presence of any bacteria. When, however, 
degeneration or death of a few or many cells has occurred, they 
readily become the pabulum for infection, and particularly for 
the strain producing that toxic substance. We have, therefore, 
as a secondary process, the infection of the lesion produced by 
the preliminary anaphylactic reaction. 

In highly vascularized tissues it becomes readily possible for 
these degeneration products to be limited quite sharply and for an 
ultimate quite complete repair by the successive processes of in- 
flammation. In the poorly vascularized tissues, however, such as 
bone, synovial membranes, dentin, etc., the repair is less simple 
and frequently less complete; and since mechanical destruction 
of hard tissue may involve much greater problems of readjustment 
and repair, fixation and deformity may readily develop. In 
these hard tissues we must recognize two distinct types of inflam- 
mat3ry reaction, one largely degenerative with the tearing down 
of hard structures, and the other proliferative with the building 
on on hard tissue and the calcifications of soft tissues, first as 
fibrosis and then a calcification of this tissue. It is not possible 




17) 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM ARTHRITIS 175 

yet, clearly to define and differentiate between these two types. 
I will, however, show illustrations of both, and with some will 
give some suggestions as to important etiological factors. 

In Chapter 3 I have discussed the different types of bone 
change found in patients and produced in rabbits by inoculation 
of different strains. The problem of prognosis is very greatly in- 
fluenced by the type of lesion that has been produced by the in- 
fection. Nature seems capable of making very complete repair 
of rheumatic group lesions in muscle tissue, and frequently very 
poor repair of lesions in bone tissues, particularly if the latter have 
involved the destruction of the vascularization. We have, ac- 
cordingly, come to be very guarded in the matter of giving en- 
couragement for marked relief in all cases of deforming arthritis, 
because of the serious structural changes, the abundance of the 
scar tissue (in this case of bony scar tissue), and the permanent 
susceptibility of such individuals; for it is generally recognized 
that in these lesions one attack predisposes another. This, 
however, can be said of most, if not all, of the rheumatic group 
lesions which are, apparently, associated with the biologic char- 
acteristics of these strains of the streptococcus group of organ- 
isms. We have, however, had some very marked improvements 
in even severe cases. Figure 335 shows such a case. 

Case No. 709. — This woman, unmarried, forty-seven, was car- 
ried to us seven years ago with such extreme deforming arthritis 
that she had been bedridden for six years. When first brought 
to us, her spine, hips, knees, and neck were so stiff that she could 
be lifted by her head when lying down and without muscular 
effort could be raised to standing position; and if she had been 
leaned against the wall, she would remain there as incapable of 
moving as a broom handle leaned against a wall. She had not 
been able to feed or wait on herself for five years. Figure 336 shows 
the teeth that were extracted at that time. She was given an 
autogenous vaccine made from the extracted teeth. Improve- 
ment was so marked and rapid that in three months' time she 
was walking with crutches, and has continued to improve con- 
tinuously for five years except at one time. She is now one of the 
busiest seamstresses in Cleveland and does most beautiful em- 
broidery and drawn- work, takes care of herself and her room, and 
with the return of her health is one of the most grateful, happy 
souls one could ever find. Her hands that were as stiff as castings, 
or nearly so, have limbered up so she can thread needles and exe- 



176 DENTAL INFECTIONS & DEGENERATIVE DI< CLINICAL VOL.I1 




I'a.i re 336. Some of teeth of previous case of deforming arthritis, extracted seven years ago. 

cute most difficult lace patterns. Her work is eagerly sought 
because of its exquisite beauty. At one time she had a return of 
her symptoms for a few months. A careful examination dis- 
closed a non-vital pulp, shown as an insert in Figure 335. This 
tooth was not painful to mastication, nor had she at this time any 
symptoms from it though there was a history of its having been 
hypersensitive to heat and cold several months previous. Note 
this tooth does not have an area of rarefaction about its apex 
expressed as radiolucency in the roentgenogram but. on the con- 
trary, an area of radicpacity due to a condensing osteitis. Her 
hands in two stages of her arthritis are shown in Figure 335. At the 
time of the extraction of this lower right first molar, a trephine 
was used to remove for sectioning a piece of the condensed bone. 
This is shown in Figure 337. Note its structure not unlike that of a 
curly maple. The blood vessels have been greatly reduced in size. 
A culture was taken from the pulp of this tooth and inoculated 
into rabbits, one of which is shown in Figure 338 with acute 
purulent arthritis with marked suppuration. 

This patient is shown in this picture with her crutches, but we 
are glad to report that since writing the above we are advised that 
she is going about her home and yard without her crutches and is. 
accordingly, progressively improving whereas she had been pro- 
gressively growing more and more bed-fast. It should be noted 
that the treatment of her case consisted not only in the removal 
of her dental infections but the use of an autogenous vaccine, 
which is a very important procedure in many of these cases whose 
defenses are just below the level needed lor keeping them on the 
aggressive fight against the strain. 







Figure 337. Histological studies of periapical bone. A, photograph of trephined 
cylinder. b, histological section. note density. c, roentgenographs appearance. 
Case No. 709. 



Still another type of deforming arthritis, which would usually 
be considered to have a very bad prognosis, affects, chiefly, the 
spine, hips, and shoulders, without much involvement of the 



177 



178 DEN1 \I.INI1 x I I0NS4 DEGENER VI IVEDISEASES e I. INK AI. VOL.11 




Figure 338. \n n purulent vrthritis produced in rabbit from culture from 

H SHOWN in C of PREVIOUS FIG1 Rl . C \-i No. 709. 



extremities. We have, however, seen such marked relief in some 
of these easts, that we have come to he much more hopeful and 
encouraging, provided there is a locked dental infection of the 
type that we have come to consider particularly causative in this 
type of disturbance. Such a case is shown in Figure 339. 




179 



180 DEN1 \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 340. Putresceni unfilled root of 
cuspid. tooth had but sligh1 apical absorp- 
TION AND No PISTULA. 



Case No. 1125. This case, a male, age forty-seven, laborer, is 
of particular interest because it seems to be very definitely re- 
lated to bad dentistry ; and while the profession of the past may 
not have been responsible for its ignorance, the time should soon 
come, and doubtless will, when the public will see to it that they 
shall not, because of ignorance, be given a lifetime of suffering, 
thus becoming dependent cripples. The dental condition in 
question, a very imperfect operation on a root canal of the upper 
left cuspid, is shown in Figure 340. The pulp chamber had been 
entered and a very incomplete root filling placed underneath the 
metal filling twenty-three years prior to the patient's presenting 
to us, with the extreme deforming arthritis with ankylosis of the 
spine. Seventeen years ago, he injured his back by lifting, this 
not being considered serious at first. Acute rheumatism set in in 
the injured tissue, stiffness began about fourteen years ago, and 
during this period he has had exacerbations with acute and pain- 
ful processes, always followed by greater stiffness following the 
course of progressive arthritis. At the time of presentation 
eighteen months ago, he was not able to rotate the body or bend 
the spine, appreciably, from his hips to his head. He had been 
compelled to give up his work and was becoming very despondent. 
The pain was extending down the left sciatic with involvement 
beginning in the left leg. The tooth in question had the history 
of having been painful at recurring periods soon after it was 
filled, but had presented no symptoms whatever of discomfort 
for many years, the patient thought not since the rheumatism 
had developed. He had no other treatment than the removal of 
this infected cuspid which was surrounded by a zone of condens- 
ing osteitis outside a zone of rarefying osteitis. As shown in the 
roentgenogram, there is a zone of excementosis on the side of the 
root. His nervous symptoms had become quite marked at the 



CHAP.LXH SKELETAL AND MUSCULAR SYSTEM ARTHRITIS 1K1 





Figure 341. Shows improvement in the movement of this man's 
spine in three months' time after extraction. a, limit of lateral 
movement at beginning. b, in three months. c, limit of forward and 
backward movement at beginning; and d, after three months. 



time of the extraction, the first effect of which was to aggravate 
them. However, in three months' time he could move his spine 
both forward and backward as well as make considerable rota- 
tion of it, as shown in the photograph, Figure No. 341, which 



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Figure 342. Susceptibility record of previous case, No. 1125. Note good dnheri- 

I \\U VLSO IN COH MNS I" RIGHT, DURATION OF CHIEF sFFEC II IN H »S I ESS Til \\ THATOF THE 
DENTAJ INFECTION. SPINA! DISTURBANCE FOLLOWED AN INJURY PLUS HIS FOCA] INFECTION. 






CHAP.LXFN SKELETAL AND MUSCULAR SYSTEM ARTHRITIS \Ki 

shows the limit of movement sideways, forward, and backward, 
before and after this three months' period. He had complete 
relief from the acute rheumatic processes; and in about six 
months, he went back to work. Life had an entirely new pros- 
pect. He changed from progressively getting worse through a 
period of fourteen years, to suddenly getting progressively 
better. Nothing was done except the removal of dental 
infection. We shall expect, however, that this patient will 
readily develop arthritic processes again and it will be quite 
probable that his improvement will not be continuous or perma- 
nent after the development of such a severe focus, which is true 
of many, if not most, of these extreme cases. 

A study of his susceptibility is particularly instructive. See 
Figure 342. His is a case of acquired susceptibility. He had 
about as bad a type of dental infection as it is possible to have: 
namely, the quantity of infection that may exist in a putrescent 
pulp and the entire dentin and tooth structure of a tooth for a 
long period of time. During the early period of the history of 
this tooth, when his resistance was high and he had no injured 
tissues, the reaction about the tooth was sufficiently good to pro- 
tect him from this infection and expressed itself, locally, in ex- 
tensive rarefaction, with an apical abscess and fistula. With a 
lowering of his resistance, he lost the ability to maintain the 
quarantine about the tooth and became injured by its contents. 
At this time the local reaction was much less efficient, the fistula 
healed and closed, and the old scar was plainly visible at the 
time we operated. It was like a quiescent volcano. The toxic 
material was now taking a new route: namely, through his sys- 
tem. It was injuring the most susceptible tissue which began 
with his injured spine. As shown in Figure 342, there were practi- 
cally no rheumatic group lesions in the brothers or sisters, sons or 
daughters, or on either side of the ancestry, his father's father 
living to be one hundred five, his father to be seventy-nine. His 
mother died at fifty with nervous disturbance developing with 
the menopause. Her parents died old. There were no cases of 
arthritis on either side of the family. His father was one of ten 
children and the father's sister is still living at ninety-five. We 
should expect that if all his overloads could be removed, the 
prognosis should be very much more favorable than in a person 
whose normal defense should not be expected to be high, which his 
should be. Clinically, this type of susceptibility does not often 



\M DENTAL INFECTIONS & DEGENERATIVE DISEASES c LINICAL VOL.11 







Figure 313. Extreme deforming arthri- 
tis PRODUCED IN A RABBIT INOCULATED WITH 

CULTURE FROM THE TOOTH SHOWN IN FIGURE 3 1". 
PREVIOUS CASE, No. 112.) 

have an involvement, as deforming arthritis, and we would put 
considerable importance upon the fact of the type of tissue that 
was injured and which thereby became a prey to his infection. 
The marked symptoms of his nervous system were in accordance 
with the general experience in cases of acquired susceptibility. 
Returning to Figure 339. it will be noted that there was a very 
marked tendency to the formation of osseous spicules on the 
spines and bodies of the vertebrae of the patient. It is very im- 
portant that the type of reaction produced in animals, with the 
culture taken from this case, was quite like that in the patient. 
One of the rabbits developed acute involvement of the spine. 
(See Figure 339) and also spicula on pelvic bones. Another de- 
veloped marked deforming arthritis with bowing of both hind legs. 
as shown in Figure 3 13. We have discussed this case in connection 
with the different expressions of bone changes, rarefying and con- 
densing, etc., in Chapter 3. 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM ARTHRITIS 185 

Case No. 896. — In comparison with the two preceding cases 
with regard to the type of bone changes, we will present as the 
next case that of a woman, age at the time of this writing forty- 
eight, who presented two years ago with a type of multiple defor- 
ming arthritis in which there was much disfigurement without ex- 
tensive arthritic deposits. This patient had not walked for five 
years, during most of which time she had not been able to feed 
herself. The extreme deformities of her feet and hands began 
about eight years ago and are shown in Figure 344, as she is 
propped up in a wheel chair for the purpose of having her photo- 
graph taken. Within four months from the time her dental infec- 
tions were removed, which was followed by a vaccine made from 
an autogenous culture, she was able to feed herself and put her 
hands to her hair, which she had not done for many years. In five 
months' time she was able to walk out of the ward of our institu- 
tion to go home to her family. This was the first time her five- 
year-old child had ever seen her mother standing on her feet or 
walking. This pregnancy occurred after she was laid up from 
rheumatism and contributed greatly to aggravating it. At this 
point, we wish to refer to the chapter in which we discuss the 
relationship of pregnancy as an overload (Chapter 21) and preg- 
nancy complications (Chapter 34). In about six months' time, 
this woman was doing all her household duties except the laundry 
work. At one time when we called on her, she was making berry 
pie. Figure 345 shows the dental conditions. Note that there has 
been a tendency to both alveolar absorption and to condensing 
osteitis. The mesial root of the lower left first molar is shown 
overgrown with bone which is distal to, and close beside, the 
lower left second bicuspid, with a curved root and surrounded by 
much condensed bone. Also note the condensing of the bone 
below the zone of rarefaction beneath the root of the lower left 
second molar. You will also note a small zone of rarefaction just 
above the imbedded root of the lower left first molar. This im- 
bedded root was removed and was found to be covered by a full 
eighth of an inch of very dense bone. A section of it was removed 
by operation in order to expose the root, which bone was sectioned 
and is shown in Figure 346. While the bone is a compact homo- 
geneous mass so far as trabecular and medullary spaces are con- 
cerned, the original trabecular structure can be traced, as shown 
in Figure 346- A. The medullary spaces had been filled in with a 
very compact bone, as shown. In Figure 346-D, a blood vessel is 
shown, the lumen of which has been so reduced in size that it is 




186 



CHAP. LXIV SKELETAL AND Ml'SC TI. AW SYSTKM \UI 




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188 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 







Figure 346. B, rm overgrown root referred to in previous figure, a. section of hum 

SHOWING ORIGINAL 01 HINT. OF TRABECULE; C AND I >. CONCENTRIC LAMINATION OBLITERATING \ 
BLOOD VESSEL. 

now but a fraction of its original cross section; and in Figure C, 
will be seen the successive layers of the laying down of bone within 
the lumen of a blood vessel. This root was cultured, the organ- 
isms growing from which were injected into rabbits, one of which. 
Figure 347, developed paralysis from the center of its spine back- 
ward, followed by a marked structural change, as shown in the 
roentgenograms, Figure 3 18. This rabbit lost complete control of 
the sphincters for urine and laces for several weeks, and dragged 




Figure 347. Various views of a rabbit paralyzed by an inoculation from dental culture from previous 
case, No. 896 

189 





%,.-».i T- 



- 



Figure 348 Lesions 01 spini 01 rabbit shown in Figuri 347 \ umd B, photographs showing diseased verte- 

ENERATIVE NECROSIS OF VERTEBRA \l>l<l\l\<. nil SPINA! CORD. 1> VND E, ROENTGENOGRAPHIC APPEAR- 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM -ARTHRITIS 191 

its hinder parts as though they were something foreign to it. It 
was not particularly sick, ate well, and made an apparently com- 
plete recovery except that it walked with difficulty, having a per- 
manent impediment, similar to a child thathas had infantile paraly- 
sis. We have motion pictures of this rabbit and many others in 
various stages. This rabbit is discussed in Chapter 21, in which 
it was used to study the effect of maternity on an apparently 
healed infection, with very striking results, as will be seen by that 
text. The structural changes in the vertebrae and spinal column 
are shown in cross section in Figure 348, our pathologist's report of 
which is as follows : 

"Inverted Oeular shows a large, irregular-shaped piece of tissue, 
representing on one side bony tissue with its marrow and one side 
the spinal cord cut half. The cord stains with a pink color; the 
bony structure is stained with a reddish color, while the marrow is 
pale pink. In between the cord and the bony structure there is a 
large blood vessel, and next to this the marrow of the bone is of a 
muddy color. 

"Low Power.- — The cord proper tissue appears mushy, the 
nuclear structures are very few, with a large amount of the inter- 
stitial tissue, which appears more or less spongy, mushy. There 
will be seen many places where the neurogliar cells appear vacuo- 
lated, nuclei staining poorly. Same changes can be seen also in 
the gray matter. All the blood vessels at the periphery of the 
cord are well dilated and some filled with blood cells. In some 
instances there can be seen a few of what appear to be round 
cells, around the blood vessels. The spinal cord membranes are 
detached, somewhat thickened. The periosteal covering of the 
bony part of the vertebral column is thickened in some places and 
all the blood vessels are markedly dilated and filled with red blood 
cells. There appears to be a marked loss of bony tissue at the 
center w^here the spinal cord is in contact with the bony structure, 
a condition of bone resorption present; the bone marrow is in- 
creased in amount, likely due to the loss of bony tissue ; otherwise, 
the marrow tissue proper appears rarefied, loss of cellular struc- 
tures, and takes a darker stain. Everywhere there are many 
dilated blood vessels in the marrow. In other places the marrow 
tissue has nearly disappeared, only a few cells left. Those spaces 
between the bony structures stain with a very light bluish stain. 

"High Power shows the same changes as above. 

"Diagnosis. — Chronic osteomyelitis of the vertebral column 
( lumbar region ) with degeneration (parenchymatous) of the spinal 
cord." 



192 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

This patient had been progressively getting worse with recur- 
ring exacerbations from which she suffered severely. She has 
been almost completely without pain since very shortly after the 
teeth were extracted and is progressively improving. We have 
motion pictures of her doing stunts and she is shown in Figure 344. 
To those dentists who have not found a supremely compensating 
joy in the practice of dentistry, we would suggest that the satis- 
faction of having been able to assist even one mother like this 
(of whom we have had many,) so that she has been enabled to go 
back to her home and carry on the duties of the household, and 
mother her several children, is sufficient to compensate for a life- 
time of effort and in a way that no monetary consideration can 
reward. Unfortunately, a large number, if not a large per cent, 
of these individuals are financially incompetent even to take care 
of the incidental expense, let alone remunerate. 

Diagnostic and Prognostic Interpretation. — A study of this 
woman's history shows that her first attack of rheumatism began 
following childbirth, fifteen years prior to her coming to us. She 
had another attack following the birth of her second child eight 
years preceding. She was unable to walk for a period after her 
attack of arthritis which followed her first childbirth fifteen years 
ago, and again with an attack that occurred after the birth of a 
child eight years ago. Each of her six pregnancies has been fol- 
lowed by acute rheumatism. The history further shows that her 
mother suffered from rheumatism and died of pneumonia at fifty- 
nine. Her one brother died at thirty-nine of heart involvement. 
Her only involvements have been rheumatism and arthritis. 
Figure 349 shows the marked disfigurement of the hand, due to the 
shortening of the flexor and adductor muscles. 

While it is too early to differentiate between the pathology or 
the etiology of these different types of arthritis, as shown in the 
last three cases, we wish to note that the last patient studied is of 
the degenerative type, while the two preceding are the prolifera- 
tive type. In the experimental chapters I have shown many 
different phases of disfunction of tissues and organs which seem 
definitely to be related to calcium metabolism. The fact, that 
patients with the proliferative arthritis tend to have a lowered 
ionic calcium at the time of the active process, whereas those with 
the degenerative arthritis tend to have a higher than normal ionic 
calcium, strongly suggests that the process is not primarily one of 
a quantitative presence of either calcium or ionic calcium, but of 
its availability and utility in the process of metabolism. In 



CHAP. l..\l\ SKE1 ETAL WD MUSC 



\R SYSTEM ARTHRITIS 



193 




Figure 349. Degenerative arthritis of hand of patient, Case No. 896, with dislocation due to shortening 
of flexor and adductor muscles. 



Chapter 43 I have shown that the available calcium in ionic form 
is largely dependent upon the demands made upon it for neu- 
tralizing improperly reduced acids, which substances normally 
should not exist in the blood and body fluids in a perfect metabolic 
state, nor should their neutralization use up the available ionic 
calcium so requisite for metabolic processes. 

But if there is a pathos in the development of deforming ar- 
thritis of adult life, it is doubly a tragedy if both the childhood and 
adult life are clouded by this misfortune. In the chapter on 
heredity, we emphasized that in cases of marked hereditary sus- 
ceptibility from both sides, the affection tended to develop, not 
only more strongly, but earlier in life in the offspring. A striking 
illustration of this is seen in the following case. 

Case No. 381. — Figure 350 shows the patient as he appeared 
at seventeen years of age when we were called to see him at the 
hospital. At that time, his mother said to me repeatedly that she 
believed she would be the happiest mother in the world if she 
could see her suffering child die and end his misery, for he cried by 



194 DENTAL INFECTIONS* DEGENERATIVE DISEASES CLINICAL VOL. II 




Figur] 350. Acute deforming arthritis in boy seventeen years of age, bedridden much of the time for 

FOUR YEARS AND CRYING BY THE HOUR WITH PAIN. ALMOST COMPLETE VBSENCE OF U.VEOLAH ABSORPTION ABOUT 
PI TRES( ENTTEETH. C ^SE NO. 381. 



the hour from acute pain, and was mere skin and bone. The ex- 
treme deformity of his hands is shown in the picture. His history 
showed that there had been very acute rheumatism on both his 
lather's and mother's sides. His father died at fifty-six from 
cerebral hemorrhage, from which affection both the father- 
father and mother died. One of the father's brothers died of 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM ARTHRITIS 195 




Figure 351. Same boy and some of his handiwork, now greatly improved but 
deformed for life. is he happy? 

heart, one of heart and rheumatism, and two had rheumatism 
severely. The mother's father had very severe rheumatism, as 
did also the mother's sister. The boy's father was an invalid as a 
young man. This boy's acute rheumatism began at four years 
of age and he was in bed for eight months. Another attack at 
five years of age made him bedridden again for many months. 
At seven years of age, he fell through the ice into ice cold water 
and before he could get his clothes off, his trousers froze on him. 
This severe exposure was followed by severe rheumatism which 
lasted for one year. His right leg was drawn up. It became 
rigid. At nine years of age, he learned to ride a tricycle, which 
took the stiffness out of both limbs. During the ninth year, he 
had both scarlet fever and measles, after which his rheumatism 
reoccurred. His attacks of acute rheumatism were preceded by 
acute nausea. At about twelve, when trying to fly a kite, he sat 
in his stiffened condition on the damp ground, which exposure was 
followed by pneumonia and acute rheumatism. At twelve years 
of age, he was carried to a dentist with severe tooth-ache. A 
devitalizing paste was placed in the tooth to devitalize the pulp. 
The boy was so frightened and hurt that he did not go back. The 
dentist warned him that the medicine should be removed, but it 



L96 DENl \l. 1M Ia I IONS& DEGENERA1 [VE DISEASES ( LINK Al. VOL.11 

was not done. The mother states that the dentist told her that if 
the medicine was left in the tooth, it would rot every bone in his 
body. ( hving to his fear, she could not persuade him to go back. 
After this incident his arthritis was progressively worse. At the 
lime we took his case it was at the request of the hospital staff as 
they suggested they were at the limit of their resources and he 
was receiving morphine to control his pain. He was entirely 
helpless and had to be fed through a tube or with a spoon, tin 
ankylosis of the mandible being so complete that nothing thicker 
than a spoon handle could be placed between the teeth. We took 
him to the x-ray room and made roentgenograms of his teeth, 
with very great difficulty, since films could only be placed flat 
between the two incisal planes. These poor and distorted pictures 
were sufficient, however, to give much important evidence, as 
shown in the inserts in Figure 350. The most striking thing is that, 
while several of these teeth had such extensive caries, that the 
pulps had been exposed for a long time and were putrescent, there 
was exceedingly little evidence of apical rarefaction and none of 
his teeth were sore or had been painful. Seven were non-vital. 
He was placed under a general anaesthetic and with exceeding 
difficulty the non-vital teeth were removed. The ankylosis of 
the mandible was so severe and rigid that it was impossible to 
open, even by force under the anaesthetic, for fear of fracturing 
the mandible. All extractions had to be done through the alveo- 
lar border, and the teeth were surrounded with much condensing 
osteitis. The incisors and bicuspids could be reached, but it w 'as 
with great difficulty that the roots of the first permanent molar, 
upper left, could be reached. A tendency to cyanosis and to 
ceased breathing kept the anaesthetist and myself in the most 
extreme anxiety, and several times the operations had to be tem- 
porarily stopped to resuscitate the patient. The buccal roots of 
this molar were found very close to a very low maxillary sinus, as 
shown. The fact that his mouth could not be opened, made the 
operation almost impossible, both because of the difficulty of 
access and of maintaining anaesthesia. Following this operation. 
he made most remarkable improvement for a few weeks, when he 
had a new attack of acute rheumatism in his left ankle, which was 
the only important joint that had not been seriously crippled. 
Because of the difficulty of taking care of him in a general hos- 
pital which is not adapted either in its equipment or in the training 
of its nurses for the care of these special dental cases, we trans- 






CHAP. I. XIV SKELETAl \ND MUSCULAR SYSTEM VRTHRITIS 19*3 




Figure 352. Rabbit with acute rheumatism, inoculated 
with a culture from a putrescent lateral shown in b. note 
the nearly complete absence of apical absorption. 

ferred him to a private room, four miles nearer the office, from 
which we could conveniently carry him to the office surgery for 
care and treatment. (We did not then have a private dental 
hospital with specially trained nurses, which we do now.) He was 
coming to know some of the thrills of a boy's heart. Some of his 
joints, particularly his knees, were so severely ankylosed as to be 
almost entirely rigid, one completely so. His improvement since 
that time has been nearly continuous except for a setback from 
pneumonia during the past winter. He rolls himself about in a 
wheel chair, sells confections and papers, and does remarkable 
carvings, some of which are shown beside him in Figure 351. He 
has made with his jacknife and handsaw, the aeroplane and pistol 
which, with its coat of aluminum paint, is so realistic that he came 
nearly being arrested for carrying firearms. The handkerchief 



Private Records of Weston A. Price. M.S.. D.D.S.. 8926 Euclid Avenue. Cleveland. 





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M \ii~-\i us BOTH SU ES ' i 1 will V. 



198 



CH M'. I. XIV SKELETAL AND MUSCULAR SYSTEM \RTHRITIS L99 




Figure 354. Roentgenographs view showing the free movement of mandible which 
before dental extractions was ankylosed closed. 



200 DEN1 VL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

box is also a remarkable evidence both of his genius and of his 
wonderful dexterity with hands that previously were so stiff that 
he could not hold a pencil or spoon. 
Our first surgical operation on his case occurred about five 

years ago. The mandibular ankylosis entirely disappeared. He 
returned to the South and we did not see him for a couple of 
years. He came back two years ago, at which time he was having 
some return of his rheumatism. He had had no further care of 
his mouth and was wearing a denture with which we replaced the 
missing teeth. A lateral was found with deep caries, with a pulp 
non-vital, but without periapical absorption of such extent and 
type as would be expected with this amount of infection, as 
shown in Figure 352. The culture was taken from the pulp of this 
tooth and inoculated into a rabbit which developed very acute 
rheumatism and is shown in Figure 352 with its right hind leg 
drawn up and which it carried when it hopped. 

DIAGNOSTIC AND PROGNOSTIC INTERPRETATION. 

The susceptibility chart for this boy is shown in Figure 353. 
We would consider, as shown, that his factor of safety is very low 
for he has by inheritance a marked susceptibility, in which con- 
dition his best will always be low. Since each attack of strepto- 
coccal infection, such as rheumatism, heart, etc., seems to make 
the individual ultimately more susceptible, he has, in addition to 
his inherited low defense, an increased acquired susceptibility. 
and every new infection of this type will tend to bring about a re- 
currence of the old symptoms. We have no thought that he ever 
can be a normal man, but he is happy to be free from pain and to 
have even the joys that a boy can have with his companions, with 
his pictures, and his business, for he has at last become an asset to 
his mother whose chain of misfortunes had left her completely 
destitute and who could not leave him for an instant to go to 
earn. But he has come to be one of the happiest souls you could 
meet, for everything in this world is by contrast. The improve- 
ment in his mandibular articulation is practically complete, as 
illustrated by the roentgenogram of his head showing the mouth 
open. Figure 351. 

OSTEOMYELITIS. 

In Chapter 3 we have discussed the different types of bone 
lesions produced by streptococcal infection of dental origin and 
presented cases and also rabbit tissues illustrating the different 




Figure 355. Extreme excementosis. Case 311 with carditis. 




Figure 356. Overgrown bicuspid root of Case 311. 
201 



202 Dl-.M MINI l.( HONS& DEGENERATIVE DISEASES CLINICAL VOL.I1 







"f 







— 
- -. 



- v. 



CHAT LXIV SKELETAL AND MUSCULAR SYSTEM— MYOSITIS 203 

types. We present here, under skeletal and muscular system 
studies, the history of a case and result of animal inoculation as 
a matter of interest and information. 

Case No. 311. — The patient, at the time of this writing seventy- 
one, has had recurring attacks of rheumatism with very severe 
cardiac disturbance, extending over a period of several years. 
The appearance of the structural changes, as revealed in the 
roentgenograms of the teeth, is particularly instructive. These 
are shown in Figure 355. Note the very extensive excementosis. 
This type of local reaction is very important. We have discussed 
the significance of this type of pathology in other chapters and 
would stress here the clinical rather than the histopathology. 
This patient did not suffer from marked rheumatism or from 
joint lesions with deposits. The root shown in Figure 356, left 
after a difficult gas extraction, made at the time she was suffering 
from a severe heart involvement, was cultured internally and the 
strain injected into rabbits. One of these is shown in Figure 357 
with marked osteomyelitis. In A the flexed position of the limb 
is shown. The animal carried it and the limb seemed painful to 
touch. B shows the mechanical displacement of the sciatic nerve, 
due to the swelling. It also shows the femur with the destruction 
of the shaft and part of the head. C shows a roentgenogram of 
both femurs with the partial destruction of the head of one femur 
and the zones of rarefying and condensing osteitis. Figure 361 
shows a longitudinal section through a zone of osteomyelitis. 

MYOSITIS. 

While neck and shoulder involvements are among the most 
frequently found lesions related to dental infection, they are very 
largely nerve involvements. Some of them, however, have very 
definite myositic lesions. This may take the form of torticollis 
with a simple muscle spasm, or with petechial hemorrhages in the 
muscles, with or without considerable local infection. In the 
latter form the involvement is very painful and slow of recovery. 
Some of the most striking lesions, produced in our animal inocula- 
tions, have been the reproduction of neck involvements with the 
culture taken from dental infections of patients suffering from 
acute neck involvements. This will be illustrated in the follow- 
ing case. 

Case No. 455. — This is the case of a woman fifty-seven years of 
age. Some years ago she had the roots of a broken tooth smoothed 
off and a plate was extended over them. These roots became in- 



204 DENT] \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL V0L.I1 

fected and with the pressure of the plate, which prevented the 
drainage from the suppuration around the teeth, this infection 
was forced more or less directly into the tissues in the circulation. 
During a period of two years a neck involvement developed with 
recurring and increasing severity until it finally became so severe 
that she was compelled to sit in a chair for eight days and nights, 
not able to lie down because of the extreme pain and discomfort. 
Because of her weakness the roots were extracted under a general 
anaesthetic. They were cultured and animals were inoculated. 
Several of these rabbits developed myositis. In order to 
determine whether the infection in the muscle tissue corre- 
sponded with that in the tooth, a local anaesthetic was 
used in the neck and a piece of the trapezius muscle 
removed, both for section and for culture. Great care was used 
in removing the tissue without contamination. The section of 
muscle, about five millimeters square, was removed, one-half of 
which was ground in sterile sand and inoculated into culture 
media. The other half was sectioned and is shown in Figure 358. 
In this section there will be seen streptococci in diploid and chain 
form within the sheath of the muscle fibres which are seen in cross 
section. The culture grown from the tissue was inoculated into a 
group of rabbits, several of which developed myositis and two 
of the rabbits showed marked neck involvements. A 
was inoculated with the culture from the tooth and B was in- 
oculated with the culture from the muscle. We have motion 
pictures of several of these rabbits which, at one time, had marked 
involvement of neck muscles with their heads turned sideways 
and with serious nervous disturbances. The patient's condition 
improved promptly and completely after removal of the infected 
roots, and she had no return of these or similar symptoms for two 
years, when suddenly the condition developed in her neck on the 
opposite side, the right side. At this time, infection was found in 
the pulp of an infected molar, the pulp being invaded by caries 
underneath an old gold crown carrying a bridge, shown in Figure 
359. With the removal of t His infection, her neck involvement 
ceased completely within twenty-four hours and she was again 
free from infection for approximately two years at which time she 
developed symptoms again in her neck and swelling in her left 
hand, as shown in Figure 360. A putrescent pulp was found in the 
lateral shown in Figure 360-B, and the extent to which the rarefy- 
ing osteitis extends behind a condensing osteitis is illustrated by 




V 










A 



€- 

*^-^ 



v ; 



Figure 358. A cross section of muscle fibers which was 

DISSECTED FROM THE TRAPEZIUS MUSCLE OF THE NECK OF A PATIENT 
WITH ACUTE TORTICOLLIS, WHICH SHOWS THE STREPTOCOCCI AND 
DIPLOCOCCI WITHIN THE SHEATH OF THE MUSCLE FIBER. CASE No. 455. 

[CHAP. LXIV — SKELETAL AND MUSCULAR SYSTEM. MYOSITIS.] 



205 



CHAP I..\I\ SKELETAL AND MUSCULAR SYSTEM MYOSITIS 207 




Figure 359. Roentgenographic appearance of a tooth with caries beneath 
a bridge which two years later produced torticollis on opposite side of neck 
of Case 455. 




Figure 360. About two years later, patient again suffered from torticollis and rheumatism. B shows 

PUTRESCENT LATERAL INCISOR APPARENTLY PRODUCING SAME; A, THE PATIENT'S SWOLLEN WRIST JOINT. D AND E, 
RABBITS WITH SWOLLEN FEET AND JOINTS WITH ACUTE RHEUMATISM. INOCULATED WITH CULTURE FROM PUTRESCENT 
LATERAL. C SHOWS A LEAD BAR IN THE TOOTH SOCKET. NOTE THE DECEPTIVE APPEARANCE OF APICAL AREA OF LATERAL 
IN B. 



20K DENTALINFEC I IONS & DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 361. Osteomyelitis produced in rabbits from culture from tooth in previous figure: 

A, NORMA! ; H. PATHOl OGICAL; C, SECTION NORMAL; I >. SE< TImn PATH H OGICAl 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM— MYOSITIS 209 

the lead wire placed in the alveolus after the extraction. Rabbits 
inoculated with the culture from this tooth developed acute 
rheumatism so that they carried a foot or hopped with great 
difficulty. Two of these are shown in D and E. One of these 
rabbits would cry with pain when the other rabbits in the cage 
would crowd it, making its rheumatic infection painful. There 
was no tendency to depositions in the joints of the patient; and 
the infection, when placed in rabbits, tended to produce an osteo- 
myelitis, a striking illustration of which is shown in Figure 361 , 
A normal, B diseased, C sectioned normal, and D sectioned 
diseased femur. 

In the cases of this and the preceding chapters, discussing the 
practical cases, we have given the detailed history of the case and 
the findings, including animal reactions first, and then followed 
these with the physical and susceptibility studies. Let us reverse 
this order and proceed as we would were the patient presenting for 
study. 

Case No. 1081 — The case in question, a woman forty-two 
years of age, presents very much underweight with the complaint 
of acute pain in the right shoulder just below the inner lower 
border of the scapula, which had been troubling her for about 
five years and which, at times, during the past two years, was so 
severe that she had to have medical aid on different occasions. 
She has also been troubled with headaches. The problem is: 
Are her teeth probably related to her disturbance, and what are 
the prospects of improvement from interference or surgical pro- 
cedure in that line? One of the first steps of course, is complete 
roentgenograms and the making of the susceptibility chart which 
is shown in Figure 362. It will be noted that her pain in the 
shoulder and headaches have been the chief disturbances. She 
has had three brothers and two sisters, one brother having had 
rheumatism. Two brothers and one sister died of tuberculosis. 
Her father and mother are both living, the former seventy-two 
and the latter sixty-nine. The father has diabetes. The mother 
has had excellent health and has not been afflicted with any of the 
rheumatic group lesions. Her father has had some kidney and 
digestive tract disturbance, but no neuritis or rheumatism or 
headache in the father and his three brothers and three sisters, or 
the mother and her two brothers and one sister. It, therefore, is 
not a family characteristic. The roentgenograms of her teeth, 



I'll) DENTALINFEC fIONS& DEGENERATIVE DISEASES CLINICAL VOL.11 



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CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM MYOSITIS 211 

Figure 363, indicate that much dental work has been done. There 
are two gold crowns with long standing apical involvements and 
no periodontoclasia. None of these teeth are painful or uncom- 
fortable. An analysis of the oral pathology and systemic suscep- 
tibility, which is shown on the bottom of the susceptibility chart, 
(Figure 362) shows as the dental infection types a previous ten- 
dency to caries, locked and condensing osteitis, also rarefying 
osteitis; the systemic relief after dental operation — complete; 
classification of susceptibility — acquired, factor of safety — fair. 
A more careful study of the roentgenograms, shown in Figure 363, 
will reveal that the long standing apical involvements which 
earlier in life had expressed themselves in extensive rarefying 
osteitis, as shown particularly in the upper right second bicuspid, 
right central, upper left first bicuspid, lower left first bicuspid, 
lower right molar, have been followed by the development of a 
zone of condensing osteitis. (See particularly the upper right 
second bicuspid and upper left second bicuspid, also shown other 
places in less marked degree.) 

What diagnosis and prognosis are suggested (by these data) on 
the presumption that the data herewith presented and the basis 
of interpretation are based upon fact? My interpretation of this 
case on this information is as follows: Her normal defense by 
inheritance should be expected to be high and there is evidence 
that it was high until recent years. Her overloads have been the 
raising of her family of four, two of whom were twins, the two 
pregnancies following closely. This woman's classification in 
regard to inheritance is acquired, and my investigations have 
shown (See Chapter 4) that when individuals with normally a 
high defense for rheumatic group lesions do break because of a 
combination of dental infections and overload, of which the 
dental infections may be a very large part, the break tends to be 
in the nervous system. We have also shown that when people 
with an acquired susceptibility, whose defense normally should be 
high, have their overloads removed, when they are chiefly dental 
infections, they tend to rebound splendidly; in other words, the 
prognosis is particularly good. These conditions must always be 
considered in conjunction with all other factors, one of the very 
important of which is the menopause in women. The structural 
changes about the roots of her teeth suggest that she has changed 
from a condition of good reaction at the apices to one of poor re- 
action, the former being an expression and therefore somewhat 
of a measure of the activity of the extent of some of the processes 



212 DENTALINFEC TIONS& DEGENERATIVE DISEASES C LINK \1 VOL. II 




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CHAP. LXIV SKELETAL AND MUSCl'LAR SYSTKM MYOSITIS 213 

and the completeness of the quarantine. I do not interpret the 
condensing osteitis surrounding the rarefied areas as being a part 
of Nature's defensive mechanism. Nature does not have that 
type of intelligence. Tissue cells react to various changes of en- 
vironment in all stages of irritation, stimulation, depression, and 
exhaustion, and the same irritant may only bring the response of 
stimulation at one time, which, under more perfect reacting condi- 
tions, will produce sufficient irritation to produce the taking up of 
lime salts instead of their deposition. Therefore, the building of 
a zone of condensed bone about the area of rarefaction is an ex- 
pression cf the change in cell membrane permeability and func- 
tion. The toxic substances developed in these teeth not only are 
not escaping through a fistula, neutralized by the blood plasma 
and exudate furnished as a part of an efficient local warfare, but 
are passing the first defense without ample obstruction and are 
going to all parts of the system in the fluids of the tissues through 
the hematogenous and lymphatic circulations. We would, there- 
fore, expect from the change in pathology, evidencing a change 
in the defensive efficiency about the tooth, that the patient has 
lost the ability to establish and maintain the quarantine about the 
infected teeth ; and if she is not already breaking in some tissue, 
she is in great danger of doing so. The fact that she is already 
breaking, as shown by the history, is just what we should expect. 

Prognosis. Since this individual's history, as shown in her 
own and her family record, and her history, as written in the 
bone changes revealed in the roentgenogram, indicates that her 
normal defense has been high, that it has been broken, that there 
is an ample source of dental toxin and bacterial infection, and 
that there has been a contributing physical overload, therefore, 
if the various overloads can be removed, she should be expected 
to come back to her normal which is high, and, therefore, since the 
dental infections form an important part of the overload and can 
be removed, the prognosis is good. 

The subsequent history of her case is as follows : These dental 
infections were removed by the removal of the teeth and curette- 
ment of the sockets. This was done eighteen months prior to 
the writing of this text and during this time she has not had 
a single recurrence of the disturbance in her right shoulder, 
which had been almost continuous for the two years previous 
and, at times, very severe. Her headaches have also dis- 




214 



CHAP. I. XIV SKELETAL AND MUSCULAR SYSTEM MYOSITIS 215 

in the roentgen-appeared. When the teeth were removed, they 

were cultured and rabbits were inoculated, one of which is shown 
in Figure 364. This rabbit developed this involvement of the neck 
and shoulders in six days after the inoculation of a very small 
quantity of the culture. It gained ten grams in weight and was 
very little disturbed in its habits in eating. When placed under 
an anaesthetic, which was done for experimental purposes, the 
muscle spasm entirely disappeared and its head ceased to be 
drawn to the side. As soon as it would come out of the anaesthe- 
sia, the muscle spasm would return and the head would go back 
into that position. The different head positions are shown in the 
illustration. Figure 364-E shows a dissection of the neck and 
spinal cord with some of the cervical nerves. Definite pathology 
was found in the muscles, as shown in Figure 364 and also in the 
nervous system, as shown in Figure 365. It is significant first that 
this rabbit, when alive, maintained its head continually in a ro- 
tated position after the development of the lesion except when 
under the influence of a general anaesthetic which unhitched the 
nervous system temporarily, in which condition there was no 
physical evidence of a lesion. The lesion was, therefore, quite 
in the nervous system. It is, therefore, important in this connec- 
tion to review the microscopic pathology of this condition, which 
is shewn in Figure 365. The histological description and micro- 
scopic diagnosis of the pathologist were as follows : 

"Rabbit 291. Spinal Cord. Microscopic Study. 

"Inverted Ocular shows a small circular-shaped piece of tissue of 
the spinal cord, stained with a pinkish blue color. There are 
apparently no changes to be seen. 

"Low Power. — The spinal cord is cut transversely. In the gray 
matter there are no changes of any kind to be noticed except at 
the proximal ends of the motor roots, there can be seen here and 
there small vacuclations, especially of the interstitial tissue. The 
blood vessels do net show any changes. The central canal with 
its ependymal lining does not show any abnormal changes. 

"White Matter. — All around the border of the section there can 
be seen here and there many vacuolations in the interstitial tis- 
sues, also some changes in the nerve fibres. The axis-cylinders in 
many cases are seen to be pushed out from their central locations 
and in many instances only wide clear spaces can be seen, without 
any axis-cylinders. There are no changes to be seen in the blood 
vessels of the periphery of the cord. 

"High Power shows the same changes as above. 




Figuri 365 Chronk degenerative myelitis of the spinas cord of rabbit of previous figure. 

216 



CHAP. I.X1V SKELETAL AND MUSCULAR SYSTEM (.AST 2\7 

"Din ptosis. Chronic degenerative myelitis (focal) of the 
spinal cord." 

This patient had also suffered from catarrhal and maxillary 
sinus involvement of the right side of her face, which has not re- 
curred since the removal of the dental infection. This case has 
responded just as we should expect it to do in accordance with 
these interpretations, and it is because of the many hundreds that 
have responded in accordance with these interpretations that I 
feel sufficiently confident now to present them as the most logical 
explanation for the observed data. Whether our interpretations 
will be found correct in all details must be left for extensive ob- 
servations by many competent observers. However, there are 
so many contributing factors that those who observe must have 
a very wide knowledge of dental and general pathology. Whereas 
in the last case with neck involvement, the lesions were strikingly 
in the nervous system, in other instances we have found them 
chiefly in the musculature. In Figure 366, A, B, and C, will be 
seen sections of the muscle of the neck of a rabbit also suffering 
from rotation, in which three different areas of muscle tissue are 
used , each of about equal width . I n the photograph they blend as 
pieces of a veneering of mahogany would tend to blend. In each 
of these there is marked degenerative and destructive involvement. 
In some muscle cells the nuclei do not stain well. The picture 
was one of acute myositis with degeneration of the muscle cells. 
In high power the organisms can be seen in some of these cases, 
as, for example, in Figure 358. 

CYST AND MUSCLE SPASM. 

Another type of dental lesion, which frequently contains toxic 
substances which seem to have very marked reaction on certain 
muscle and nerve tissues, is the dental cyst. We have seen a very 
large variety of systemic disturbances produced by these. A 
typical case is shown in the following. 

Case No. 978. — Figure 367-D shows the location of the 
disturbance in the muscles of the neck and back where it had been 
becoming progressively more severe for two years, the last nine 
months of which the patient could not raise his hands higher than 
his shoulders. The trouble began seven years previously as rheu- 
matism acutely in his right arm. Roentgenograms of his face 
showed a large cyst below the lower left bicuspids and molars, 
apparently, directly related to mesial root, partially root-filled, of 
the first molar. Its extent is also clearly shown in the roentgen- 







<- 



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I'K. I RE 366. TllKI I SI ( riONS 01 Ml scli rissi E FROM neck of another rabbit suffering from 
rqRTicoi i is. 

218 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM— CYST 219 




B 



Figure 367. An acute involvement of the muscle of the neck and shoulders shown in D, related to 

THE CYST SHOWN IN C AND B. OPERATION FOLLOWED BY RAPID AND MARKED IMPROVEMENT. A, A PARALYZED RABBIT 
INOCULATED FROM CULTURE OF SAME. 

ogram of the mandible, made after the extraction of the teeth. 
The surgical treatment of this case was as follows : Owing to the 
involvement of the inferior dental nerve and the blood vessels 
which would, of necessity, be injured, if not destroyed, by a com- 
plete curettement of the cyst chamber, a liberal section of the 
alveolar wall was removed and the membrane of the mouth al- 
lowed to develop into the cyst chamber and replace the cyst mem- 
brane. Where the cyst wall was trephined, the tissue and mem- 
brane were removed intact for sectioning, shown in Figure 368. 
The pathological picture is very interesting. Where the cyst 
membrane is in contact with the alveolar bone, extensions are 



220 DENTALINFEX HONS & DEGENERATIVE DISEASES CLINICAL VOL. II 



>&'<<£&& 







V 







Figure 368. A section from the cyst wall of prkyiois fk.ikk. Note osteoclastic 

ACTIVITY. 



seen thrusting themselves into the bony structure in the process 
of undermining and absorbing it. Osteoclasts and giant cells 
are seen, in the higher powers, in the act of taking down the 
bony structure. The detailed pathological interpretation is as 
follows: 

"I >ira ltd ocular shows a circumscribed area of bluish stain. 



CHAP. LXIV SKELETAL AND Ml SCI I. AR SYSTEM CYST '1'1\ 

surrounded with a narrow zone of a red color. The greater part 
appears to be composed of a dense, compact tissue and a swollen 
portion, resembling very much gland tissue. Low powei shows a 
great portion of the section to be composed of a large number of 
connective tissue fibres, arranged in a wavy manner. A large 
number of blood capillaries, distended and filled with blood, can 
be seen. The tissue, which resembles a gland under inverted 
ocular, shows the epithelium stratified. The papillae show de- 
generative processes with many young blood vessels. At some 
places, there are areas of proliferative cells accumulated around 
blood vessels." 

The pathological studies of the cyst are discussed under 
Chapter 69. A very important factor of this case is the follow- 
ing: Within five hours after the opening and draining of the 
cyst chamber, the patient felt the distinct relaxation in the ten- 
sion and spasm of the muscles of his shoulders. He could already 
raise his hands higher than for some time previously. In twelve 
hours there was a marked improvement, and by the next day he 
could place his hands high over his head. It is now two years 
since this operation was made; and while his trouble was not 
entirely corrected, his condition was very greatly improved and 
has remained so with but one marked recurrence, the details of 
which are particularly important and were as follows: In order 
to protect the cyst chamber and its delicate tissues, for the in- 
ferior dental nerve and arteries and blood vessels were clearly 
visible passing along the floor of the cyst, a removable restoration 
was made replacing the missing teeth by supporting on clasps on 
the teeth adjoining the space. This not only restored occlusion, 
but prevented the food from getting into the cyst chamber which 
for some days after the operation was packed and irrigated with 
normal salt solution daily. This became so comfortable that the 
patient forgot to remove the denture and irrigate the cyst cham- 
ber twice daily, as directed, and it received no attention for sev- 
eral days. He presented at the office with considerable alarm 
because of evidence of return of the old distressing symptoms. 
When asked if he was irrigating the chamber with a special wash 
as directed, he realized that he had not done so for several days. 
The symptoms promptly and entirely disappeared again with the 
reestablishment of the irrigation, which emphasizes the impor- 
tance, as we have seen in many other cases, of maintaining com- 



222 DENTAL INFECTIONS& DEGENERATIVE DISEASES CLINICAL V0L.U 

plete freedom from retention of the fluids of the cyst until Nature 
has replaced the cyst membrane with the extended mucous mem- 
brane of the mouth. A culture was made from the cyst fluid 
which was inoculated into a rabbit which is shown in Figure 367-A, 
carrying its hind leg. 

A photograph showing the cyst contents is seen in Figure 369. 
The large crystals are cholesterol. These cyst fluids are dis- 
cussed in Chapter 69 under Cysts. 







FIGURE 369. A PHOTOGRAPH OF THE C( NTENTS OF THE CYST 

shown i\ Figure 367. Large crystals \m cholesterol. 



RETAINED GRANULOMA AND RHEUMATISM. 

In former years, owing to the little knowledge of dental pa- 
thology, little or no attention was paid to the sockets after the 
extraction of teeth. If the granuloma remained attached to the 
tooth, the tooth was considered particularly dangerous because 
it had the so-called pus sac. If it chanced to remain in the al- 
veolus, its presence was not discovered. The accumulating evi- 
dence of these old cases strongly suggests that many individuals 
have suffered serious harm because of the lack of proper curettage 
at the time of extraction and the proper treatment of the sockets. 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM— RHEUMATISM 223 



Figure 370. A small dental cyst before and after operation, possibly 

ORIGINALLY A DENTAL GRANULOMA. 

Such a case is shown in Figure 370. A shows an overgrown granu- 
loma in the position formerly occupied by the right first perma- 
nent molar, which was extracted thirteen years previously, and 
which, during the patient's memory, was abscessed. Of late years, 
the patient had suffered from rheumatism. An operation was 
made by me to remove this overgrown granuloma by trephining 
a section of the dense alveolar bone from directly over its point 
of nearest approach from the buccal aspect. The bone surround- 
ing the granuloma was exceedingly dense and the bony chamber, 
when it was enucleated, had a dense glistening surface that to a 
sharp pointed instrument felt almost like glass. After the re- 
moval of this granuloma and the curettement of the surrounding 
condensed bone, this patient's rheumatism, the cause of which 
had been obscure, disappeared and has not returned as such for 
four years. 

In the light of my various studies I would be inclined to inter- 
pret this patient as having a low factor of safety from other 
causes, and the removal of the granuloma might relieve the system 
of the source of infection to complicate the general picture, but 
wculd not relieve it of the other contributing factors. Indeed, 
this is borne out in this very patient's history in the fact, that she 
developed nephritis; and while her nephritis may have been re- 
lated to other dental conditions, (I think, however, here again 
they were only contributary,) the granuloma that we removed 
probably was not an important contributing factor in the develop- 
ment of her nephritis, since it apparently developed after the 



224 DENTALINFEC HONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

removal of the granuloma. There probably is great danger that, 
because of our limited knowledge of the symptom complex of a 

patient and of cither normal or abnormal tissue reactions, we 
will look for causes as being more simple and isolated than a li- 
the facts. 

In Chapter 60, under Circulatory System, I cite a 
case of very marked muscle atrophy, rheumatism, and heart, 
associated with a type of rheumatism which is very painful. 
This patient, Case No. 1009, had, as I noted, suffered an attack of 
infantile paralysis in childhood, from which she quite completely 
recovered, had a normal life as a girl and young woman, married, 
and had several pregnancies and miscarriages close together, 
which so reduced her vitality that she developed a type of ar- 
thritis which I have discussed as degenerative in form. In Figure 
289 will be seen the roentgenograms of the teeth of this patient. 

I wish to call attention particularly to the fact, that, whereas, 
I have said over and over in this book that people with strong 
rheumatic tendencies tend to have very slight rarefying osteitis 
either at apices or at gingival margins as the result of irritations, 
yet, in this case there is very marked evidence of periodonto- 
clasia. This will be particularly noted about the molars and 
bicuspids of the lower jaw and the incisors of the upper. I wish 
to stress that this is not a contradiction, but an illustration of the 
exception to which I have referred in several chapters as the type 
with the degenerative form of arthritis instead of the proliferative 
form, and which is accompanied by a normal or even high ionic 
calcium of the blood in contrast with the depressed ionic calcium 
of the proliferative type. It seems very probable that the type 
of calcium metabolism disturbance associated with this lesion is 
distinctly different from that of the other type. I have discussed 
this in relation to the role of calcium in neutralizing acid products 
of the blood when the blood itself is carrying these imperfect 
products of oxidation and when bases less costly to the organism 
or to the individual are not available. 

The following items should be noted in this case, which is 
typical of a group containing many individuals: The process of 
sacrificing bony structures, when the available supply of calcium 
is not adequate, with the development of periodontoclasia and 
the degenerative types of csieitis about joints, is in keeping with 
this general group of symptoms. In this connection it is also of 
interest to note that while this patient had suffered from atrophy 



CHAP. LXIV SKELETA] & MUSCULAR SYSTEM RHEUMATISM 225 

of certain muscles, as a result of her infantile paralysis of child- 
hood, these had not been structurally conspicuous and inconven- 
ient handicaps until the development of this degenerative type 
of rheumatic arthritis. During this process the muscle atrophy 
developed to such an extent that if her head would accidently 
swing back tec far, she would be entirely helpless to raise it again 
unless someone would come to lift it to a balanced position 
above her shoulders, due to the almost complete loss of function 
of the sternomastoid and associated muscles. After the removal 
of her dental infections, by the removal of the teeth with the 
periodontoclasia pockets, and the use of the vaccine, which, as I 
previously noted, produced so marked a change in all of her 
symptoms, including the improvement in her badly infected 
heart, and although she had been an invalid for a couple of years, 
she was restored to very comfortable health and capable of walk- 
ing distances where previously she had to be carried or taken in a 
wheel chair. 

I would stress again that we must not think of calcium metabo- 
lism disturbances as being so simple as that a depressed ionic 
calcium is directly a measure of the disturbed metabolism. In 
Chapter 66, I have discussed in detail a case (No. 484) of very 
extreme muscle atrophy, involving the right arm so that it was 
only about one-half the size of the left and was so nearly helpless 
that the individual could not carry five pounds with it. After the 
removal of the dental infections, this man's arm so greatly im- 
proved that he could swing a pail full of water over his head and 
could use a heavy sledge hammer, a thing he had not been able 
to do for twenty years. The relation of this type of muscle 
atrcphy to the enervation of these muscles is discussed in detail 
in that chapter; and we must think of the muscle lesions, which 
we are discussing in this chapter, as being very frequently related 
to involvements of the nervous system. 

A discussion of the lesions of the muscular and skeletal struc- 
tures would not be complete without the inclusion of a discussion 
of the relationship of the systemic involvement, expressing itself 
in general deforming arthritis, and the health and comfort of the 
teeth of the individual. In Chapter 40 on Dental Involvements 
Caused by Arthritis, I have presented researches directed specifi- 
cally to the disclosing of this relationship. These revealed that in a 
manner quite similar to that in which arthritic processes involve 
and destroy synovial membranes and adjacent structures of 



226DEN1 M.IMIa HONS& DEGENERATIVE DISEASES CLINICAL \()L.II 

joints, so that same systemic involvement may injure and involve 
the supporting structures of the teeth and their pulps. I have 
cited in that chapter several cases illustrating this direct expres- 
sion of the systemic disturbance in the dental conditions. 

One of the most striking of these is Case No. 355, in whose 
mouth a number of teeth have become involved in succession, 
some of them coming finally to have non-vital pulps, without that 
destruction process being related to caries, trauma, or other 
natural causes. To save repetition I will not repeat here the illus- 
trations, but will refer to them in Figure 29, Chapter 3. I do, 
however, feel it necessary to repeat the important substance that 
the roentgenogram of the upper right second bicuspid, shown in 
Figure 29, which was made in 1901, revealed a zone of very 
definite radiolucency, indicating a periapical absorption. I, at 
that time, treated the tooth and filled its root in accordance with 
the best knowledge of that period. Kindly note that from the 
standpoint of usual interpretation, there is every evidence that 
my operation was a success, since the rarefied area became nor- 
mally radiopaque by the year 1914. By 1916, when my re- 
searches had advanced to a point where I was fearful for the 
safety of patients carrying such conditions, it is important to note 
that the periapical bone had become more than normally dense. 
During these fifteen years this patient had been getting progres- 
sively more and more involved with deforming arthritis, having 
come to a condition in which she was almost helpless, having to 
be carried or move herself with very great difficulty on crutches. 
It is also important to note that when this tooth was extracted by 
a method which was deemed adequate to destroy all living organ- 
isms namely, the use of an electric cautery to sear as deeply 
as it could reach into the tissues about the neck of the tooth before 
its extraction the periapical tissues showed, on culture, the 
presence of a diplo- and strepto-coccus, which organism was also 
found in the bone for a distance of one-fourth of an inch beyond 
the alveolus. These cultures, when inoculated into rabbits, pro- 
duced joint lesions, which, in itself, is not strikingly significant, 
since streptococcal infections from various types of dental sources 
lend to produce involvements of joints. The percentage, how- 
ever, is much higher when the culture is taken from patients 
suffering from acute processes. 

With the removal of this patient's involved dental conditions, 
which existed at that time and which have developed since, there 



CHAP. 1.XIY SKELETAL AND MUSCULAR SYSTEM OSTEOMYELITIS 227 

has been, continually, evidence of a direct relationship, both dem- 
onstrating that the teeth were causative in her case in making the 
systemic involvement worse, and also that her systemic condition 
attacked the teeth with structural and functional changes in the 
peridental membrane, with absorption of cementum and fibrosis 
and calcification of the dental pulps. In one of the last teeth 
extracted, also illustrated in Chapter 40, the pulp chamber was 
practically entirely obliterated by one huge pulp stone, with the 
remarkable coincident condition that the tooth was not only still 
hypersensitive to thermal change, but to instrumentation and 
irritation of the dentin at its gingival border. This patient has 
been so confident that the removal of her involved dental condi- 
tions has improved the systemic, that no compensation in the 
world could induce her to have one of these teeth back if she could. 
Her marked systemic improvement following these dental in- 
volvements has seemed to justify this confidence on her part. 

That dental infections are directly related to osteomyelitis 
seems to be abundantly illustrated by the many instances of 
progressive involvement of the medulla of the bone. On cultur- 
ing, these usually show streptococcal involvement. Their pro- 
gressive invasion of normal tissue may be so rapid as to involve 
the entire mandible or one or both maxillary bones, or any part 
thereof. That these are related directly to streptococci has, as I 
suggested, been very frequently observed and reported. I wish 
to present here a case which, however, seems very definitely to be 
related also to a spirochete invasion. 

Case No. 1417. — This young man, age twenty, presents with 
the following symptoms and history. Following the extraction of 
the left central incisor, because of an apical abscess, a very acute 
infection spread to and involved the maxilla and all the teeth, 
including the first molars, and so violently that he was taken to 
the hospital instead of returning to the exodontist who made the 
extraction. He lost twenty-five pounds in a week, and when 
brought to me by his dentist, while he was sufficiently improved 
to walk, pus was discharging from the roof of the mouth and from 
five fistulae on the buccal and gingival surfaces of the alveolus 
between the central incisor and the left first molar. Several of the 
teeth were so loose that it seemed they could be picked from his 
mouth with the fingers. These are shown roentgenographically 
in Figure 371, and some were made with flexible gutta- 
percha points to aid in the differentiation. The bone seemed non- 



22H DENTALINFEX flONS & DEGENERATIVE DISEASES CLINIC \I. VOL.I1 




Figure 371. Roentgenographk appearance of an osteomyelitis of the maxilla following an extrac- 
tion. See Chapter 13, Volume One. 

vital for some distance about several of these fistulae. The 
smears from the aspirated material revealed under the dark field 
a profuse culture of spirochetes in addition to the streptococci. 
This has suggested immediately the possibility, if not probability, 
that his infection had been an extension of a periodontoclasia to 
the alveolus. A bacterial examination of his gingival infection 
revealed an abundance of a similar spirochete. 

It is interesting to try to visualize what has taken place in 
this young man's condition. Both his age and the type of re- 
action about his teeth would suggest a good capacity for defense. 
Why, then, did his invasion become so rampant? When we 
review his clinical history we find that an effort had been made by 
treatment and root filling to save this tooth which had an infected 
pulp and which latter produced the violent apical involvement 
immediately following the placing of a gold inlay. When infec- 
tion is retained under pressure, there must either be a tremen- 
dously active reaction and inflammatory combat in the immediate 
vicinity, with an adequate vent for discharge, or the toxic sub- 
stances will enter the system. If the high defense shall be main- 
tained, the toxic products of the warfare will be discharged into 
the lymphatic and hematogenous circulations. But in this young 
man's case, his abscessing incisor was retained long enough for 
his eve to be swollen nearly shut before the extraction of the 



CHAP. l.XIY SKELETAL AND Ml'SCTLAR SYSTEM OSTEOMYELITIS 229 

tooth. There was. accordingly, a great deal of local and therefore, 
of necessity, systemic involvement with the toxic substance of 
this warfare. 

We also note from the history that he lost twenty-five 
pounds in eleven days, 17 per cent. This again suggests 
just such a reaction in loss of weight as we have demonstrated 
to occur in rabbits when the infection of planting the 
tooth is permitted to overwhelm them, for his percentage 
loss per day was approximately 2 per cent, which was 
the amount we have shown to occur in rabbits, and represents 
such an infection and toxic invasion as will very greatly 
reduce the defensive powers of the blood and very greatly reduce 
the ionic calcium. It is, therefore, of interest to note that just as 
a reduction of 15 to 20 per cent in the weight of a rabbit will 
usually represent a reduction in the ionic calcium of the blood of 
at least 10 per cent, just so this young man's ionic calcium wes 
reduced approximately 10 per cent. But even more important, 
there was a pathologically combined calcium of 3.35, which is 
very unusually high for even pathological cases. The alkalinity 
index of his blood was reduced to 2.66, and in a few days' time 
had increased to 34. 

We have, then, a suggested means for reinforcing his defense ; and 
it is also of interest to note, that placing him on a regime for the 
increasing of his ionic calcium and the reinforcing of his defense, 
has almost immediately checked the activity and spreading of 
the infective invasion. He was placed on parathyroid extract 
with quite rapidly diminishing dosage, three-tenths the first 
twenty-four hours, two-tenths the second twenty-four hours, and 
one-tenth per twenty-four hours daily for a few days, together 
with calcium lactate, three tablets with each meal, and in a week's 
time his ionic calcium was back to normal and his general sys- 
temic condition practically normal. 

But a matter of perhaps greater interest is the following : Whereas, 
in this type of case the usual procedure would be to extract all 
the involved and lcose teeth and make extensive curettage, no 
teeth were extracted, thorough and frequent irrigations being 
used through the fistulse in order that such of these teeth as 
might remain vital and be retained, could do so. This program 
was adopted, based on my experience of several years, in which 
I have found that, frequently, teeth, that would be considered so 



I hi. VI \l. [NFEC l [ONS& DEGENERATIVE DISEASES CLINICAL VOL. II 

seriously involved as to be utterly incapable of reattachment, have 
been retained and their vitality retained. This program, however, 
would not be adequate unless there accompanied it a very careful 
interpretation of the reactive capacity of the patient, by studying 
the bactericidal properties of the blood in vitro, as well as deter- 
mining the ionic calcium and the other factors such as blood 
morphology. I present this case to illustrate how that with a 
better knowledge of the pathological processes involved, and a 
study of the efficiency of the mechanisms of defense, very much 
more conservative programs will not only be justified but ur- 
gently indicated, for fundamentally this bush-fire type of infec- 
tion is pr marily dependent upon a temporarily broken defense. 

Another indication of the toxic phase involved in this case is 
the fact, that his polymorphonuclears were 59 per cent, his small 
lymphocytes 30 per cent, with his total leucocyte count 8, 100, 
which relationship was changed in one week's time to polymor- 
phonuclears 70 per cent, small lymphocytes 20 per cent. The 
bactericidal efficiency of his blood was approximately 50 per 
cent of normal at the time of his serious involvement and one 
week later had increased to 80 per cent. 

He has been saved the serious deformity which would have at- 
tended the extensive extractions and curretage of all involved 
tissue, for the palate and alveolar ridge have been permitted to 
rebuild in its original form, and whether the teeth are retained 
for most of his lifetime or not, the ridge is retained, and therefore 
his facial expression has been conserved, and this to no disad- 
vantage. Later one tooth was extracted and the sequestrum 
surgically removed, the teeth being supported by a splint while 
new bone was being formed. 

In Volume I. I have discussed in various chapters, factors that 
are involved, and which contribute to determining the type of 
expression of dental infections, particularly the changes that de- 
velop in the hard structures. These involve variations in defen- 
sive factors of the patient, which modify the local expression di- 
rectly and indirectly by modifying the organisms involved since 
the organism tends to develop characteristic qualities dependent 
upon the pabulum or culture medium furnished by the host. The 
arthritides may be expressed with extensive proliferations with 
osseous hypertrophies, or may be characterized quite largely by 
degenerative destructive wasting processes which later involve 
not only the involved surfaces but a decalcification of the bodv of 



CHAP. I. XIV SKELETAL AND MUSCULAR SYSTEM— RHEUMATISM 231 

the bone. In some instances both of these conditions will be in 
progress at the same time in different parts of a joint or in differ- 
ent joints. 

It is remarkable how rapidly these progressive degenerative 
processes may develop and progress. This can be illustrated by 
reference to many of the illustrations in these two volumes, most 
of which, however, have not been sectioned or presented to illus- 
trate this point. It can well be seen in Figures 372 and 373, 
which show the articulating surfaces of the knee joint of a rabbit 
in each the normal and the arthritic involvement, and are larger 
views of the frontispiece of this volume. Twelve days after the 
rabbit was inoculated with 1 cc. of the anaerobic strain grown 
from an infected tooth of Case No. 1414, it developed a swelling 
of the left knee joint and favored that limb. Twelve days later 
it was chloroformed and the tissues taken for section, Figure 
372 showing the normal right knee and Figure 373 the in- 
volved left knee. By reference to the normal, it will be noted 
that the articulating surfaces of the heads of the femur and tibia 
have smooth even surfaces, supported by the well developed 
trabecular structure of the epiphyses. The joint capsule, medial 
meniscus and the synovial membranes are all in excellent condi- 
tion and can readily be differentiated. 

In comparison with this it will be seen by referring to Figure 
373, that the arthritic knee has undergone very extensive 
change. First, it should be noted that there is slight difference 
in the plane from which the sections are taken, which does not, 
however, modify the pathological picture. The difference in 
size is due to swelling. In the arthritic joint there has been very 
extensive inflammatory destruction of the joint capsule, with its 
rupture. The pus escaped when the tissues were prepared. The 
trabecular of the epiphyses are undergoing decalcification and 
the articulating surfaces and their cartilages have been very 
seriously mutilated by the inflammatory process. The posterior 
cruciate ligament appears in this section though but slightly in 
the former. Its attachments have been seriously injured and its 
body is undergoing necrosis. 

It can easily be understood how such an inflammatory process, 
destroying the synovial membranes, joint cartilages, ligaments, 
and capsule, would in a proliferative process tend to throw down 
a deposit of bone quite regardless of form and function, and 
would tend to produce a condition which would be entirely im- 



w 







FICURE372 NORMAl ARTICULATING SURFACES Ol RABBIT'S KNEE. NOTl EXCELLENT CONDITION OF CARTILAGES, 

i \I'M i | . \\|. IOIN1 STRI i n Rl S. 

232 







Figure 373. Pathological articulating surfaces of rabbit's knee with acute rheumatism. Slightly 
different plane from previous figure. note necrosis of posterior cruciate ligament and cartilages. 



233 




\ 




m 



I n. I K'l 374. O MPARISON I I N( RMA1 AND ARTHRITK KNEE JOINTS OF RABBIT IN NEARLY CORRESPONDING 
PI \M - \M> DIFFEREN1 PI Wi- FROM mi PRECEDING I I « - 1 KM - : UPPER, PATHOLOGICAL; LOWER, NORMAL. 

234 



CHAP. LXIV SKELETAL AND MUSCULAR SYSTEM ARTHRITIS 235 

mobile, if not a continuous dense bone from one long bone to the 
other. When we realize that this degenerative process which 
would with certainty have destroyed the function of this knee 
was produced from the inoculation of a quantity of germs, which, 
when separated from the solution in which they were suspended, 
would not have a bulk half as large as the head of a pin, and 
which would weigh approximately one or two thousandths of a 
gram, we realize somewhat of the potential possibility of these 
organisms, particularly when we realize that they were thrown 
into the entire blood stream with its relatively large capacity for 
defensive process. I have shown in Chapter 42 of Volume I, the 
difference in the defensive qualities of different bloods. The or- 
ganisms injected into this rabbit would pass by way of the cir- 
culation to practically all organs and tissues of the animal's 
body and would survive in those tissues only, which had the low 
capacity for attacking them, assuming some of them failed to be 
killed by the blood stream. 

When we realize that this reactive response of the blood may 
call from the leucocytes the bactericidins within one minute's 
time after the injection of the organisms, we realize how quickly 
the germs must get into some protected position if they will ulti- 
mately survive. Unfortunately for humanity the streptococcus 
contains in its protective mechanisms, defenses which are very 
hard to overcome even under favorable conditions. When, how- 
ever, these organisms find a lodgment in tissues that have very 
pure vascularization and deficient in defensive fluids, they tend 
readily to proliferate. Their method of warfare is not, however, 
entirely a defensive one, for, as I have illustrated in Volume I, 
they generate toxic substances which tend to paralyze the leu- 
cocytes and thereby incapacitate them for their normal function. 
The warfare, therefore, may be a progressive one with very ex- 
tensive degenerative processes, or there may be a truce in which 
the organisms will be surrounded by bactericidal and physical 
obstructions which will compel them to limit their activity to a 
balance between their own toxicity and supply of nutriment on 
one side, and the defensive mechanisms of the host on the other. 
The streptococci in this form may take on a very low grade vi- 
tality in which they will produce exceedingly little irritation to 
the host, under which conditions the host withdraws, or fails to 
develop its defensive fluids to resist the organisms and their 
toxins. This apparently quiescent process may then become a 



236 DENTAL INFEX [TONS & DEGENERATIVE DISEASES CLINK \1. VOL. II 

new primary locus from which new infections will proceed to 
attack other tissues near or far. and it is doubtful if an individual 
so attacked can ever be sure that the infection has been entirely 
destroyed, for the evidence seems very conclusive that these 
processes tend to light up again when irritated, (ioadby has 
shown that streptococci in wounds in bone may lie dormant 
for years, and on so trivial an accident as the bumping 
of the shin and thereby starting an inflammatory proo 
the encysted streptococci may begin an active aggressive 
process and kill the host. Every individual, therefore, who has 
had an attack of rheumatism or heart involvement, or other 
streptococcal organ and tissue invasion, may be handicapped for 
life and alwa\ s live in the presence of an impending great danger, 
and on the strength of statistics must be considered to have his 
or her life prospect and possibly duration definitely reduced. It 
is therefore not an unimportant matter to wait until a dental 
infection has produced evidence of harm before eliminating it. 
No course is a truly efficient one in the treatment of disease 
which does not prevent it. 

A very serious and frequent effect produced by cultures taken 
from teeth, when inoculated into rabbits, is the production of 
osteomyelitic processes of the spine. One of the very distressing 
disturbances which the surgeon encounters, is a Pott's disease 
involving the vertebral column so seriously as to produce gross 
deformity and grave disturbance. In Figure 375 will be seen a 
number of lesions of the spine which have developed in rabbits 
so inoculated. B shows a rcentgenographic view of the spine of a 
rabbit in which paralysis was produced, and it will be noted that 
there is a marked condensing osteitis with a destruction of the 
intervertebral cartilage and a condensing deformity of the proxi- 
mal ing surfaces of the vertebrae. A shows the dissection and the 
pinching of the spinal cord produced by this bacterial invasion. 
B shows the roentgenograph^ appearance from the lateral aspect . 
E shows the photograph of a ventral surface of a spine of another 
rabbit. Note the destruction of the intervertebral cartilage and a 
localized zone of inflammation and hypertrophy. D shows a 
lateral view of this case after the lateral walls of the vertebra' 
had been removed, and it will be seen that there is distinct nodule 
formation on the ventral surface of the cord, involving the bodies 
of two vertebra*. A cross section of the spinal column and cord. 
involving the bodies of the vertebrae, will be seen in Figure 348, 

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Figure 375. Severe spinal lesions produced in rabbits by the injection of cultures from dental in- 
fections. 



237 



238 DEN 1 \l. IMIa I [ONS& DEGENERATIVE DISEASES CLINICAL VOL II 

where it is discussed under skeletal and muscular system in de- 
forming arthritis. C shows another spinal involvement. 

We have made progressive studies of some of these spine le- 
sions, a typical illustration of which will be seen in Figure 376. 
This rabbit shows in A the beginning of a distinct condensing 
osteitis involving three vertebra and two articulations. This 
rabbit had been inoculated with the culture from the teeth of 
l ase No. 1178, the rabbits of which case nearly all developed 
joint and bone, and nervous system involvements. There was a 
progressive increase of the condensing osteitis, as shown in B and 
C, the latter being four months later than the first. 

This is particularly instructive since many, if not most, of the 
members of the dental and medical professions, and therefore 
of the laity who have been instructed by them, expect an infec- 
tion process in bone to express itself with the removal of bone and 
the formation of a chamber, and therefore a radiolucent area. In 
humans, as I have shown, we find the type of bone change that 
is produced is dependent upon the type of reaction of that in- 
dividual and will be different in the same individuals at different 
times in accordance with his or her capacity for reaction, hence a 
condensing osteitis surrounding a zone of rarefying osteitis, etc. 
I have also shown that this quality is one that is characteristic 
of families, and, therefore, in part a mendelian trait and subject 
to the laws of heredity. In rabbits we do not find a difference in 
reaction in different litters, which would correspond to the human 
type of reaction. There is strong evidence, however, that if the 
organisms are transferred from the human in sufficiently young 
generations, they will carry over to the new host somewhat of 
the same tissue elective localization quality which that strain 
acquired in the previous host. Rabbits like most of the biological 
units tend to adapt themselves to any fixed conditions and en- 
vironments and, as I have shown in the chapters on blood chemis- 
try, infections, whether introduced by intravenous cr subcuta- 
neous injections, readily present changed factors of resistance and 
therefore of safety, and just as individuals, who have once 
broken seriously with streptococcal infection, tend to be more 
liable to infection of the same type in the future, similarly, rab- 
bits that have had developed in their bodies arthritis, seem never 
to regain again their original defense. 



CHAP. LXrV SKELETAL AND MUSCULAR SYSTEM -SPINAL 239 








Figure 3*6. Progressing development of a spinal disease resembling Pott's, from 
inoculation of a dental culture. 



J 



240 DENTAL INFEC I U NS & DEGENERATIVE DISEASES CLINICAL VOL.11 

OSTEOMALA( I \. 

There are many gradations in degree of the tendency to build 
up and take down bone in the various pathological lesions, rang- 
ing from the extreme arthrilides, in which in some install 
practically every joint of the body is obliterated and a skeleton 
becomes one continuous casting of bone, often with extensive 
hypertrophic deposits, to the gradual and extensive decalcifica- 
tion of bones producing an equally severe lesion as an osteoma- 
lacia. In order that this may be more clearly understood, I 
have presented in Figure 'Ml . three hands representing these 
two extremes with a normal in the middle. The ages of these in- 
dividuals do not differ sufficiently to enter seriously into con- 
sideration. B is the normal, and it will be noted that the carpal 
bones are all quite uniformly dense but with distinct separating 
cartilages. The metacarpal bones, like the other long bones of 
the body, show a splendid calcification of the shaft and have their 
epiphyses completely ossified and attached with almost complete 
obliteration of the junction of the epiphysis with the shaft. In 
comparison with this will be seen that in A there is a very marked 
accentuation of the deposition of lime salts, as represented by the 
greatly increased radicpacity. The contraction of the muscles 
has tended to produce much deformity, and there are hyper- 
trophic deposits around nearly all articulations. The carpal 
bones are fused together and have largely lost their unit charac- 
ters. In C we have the hands of a patient with osteomalacia. In 
general, there is much less opacity to the Roentgen-rays through- 
out all the bones. The carpal bones not only have less density 
but have abnormally thick cartilages separating them. The 
epiphyseal junction of the shafts of the long bones is still quite 
visible in many of the ossifications. 

The three groups which will be represented by these three in- 
dividuals have several characteristics. Those of Group A seldom, 
if ever, have periodontoclasia and but slight reaction about teeth 
resulting from local irritants, such as crowns and food packs. 
These in Group C tend very rapidly to periodontoclasia in its 
most extreme and obstinate forms. Those in Group B react to 
irritants with absorption in a moderate degree and respond well 
to treatment. Almost universally it would be said of the group 
in A that their teeth extract with great difficulty and are slow in 
healing, amounting frequently to so-called dry socket. The 
teeth of the individuals in Group C extract exceedingly easily. 




I* 











Figure 377. Three types of ossification: B. normal; A. proliferative arthritis: C. osteomalacia. 

241 



242 I>l.\l \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 

/Anesthesia is produced with great ease, and except in the ad- 
vance stages there is little after-trouble from sockets. The in- 
dividuals in Group A, whether suffering from deforming arthritis 
or a mild tendency to it, tend readily to develop excementosis. 
Those in Group C not only do not produce excementosis but on 
the contrary produce a marked thinning of the cementum of the 
tooth, as we shall show later. Those in Group A tend to develop 
calcifications of the pulp with pulp stones, whether suffering 
from arthritis or simply of that group classification, not having 
broken. The individuals of Group C practically never have pulp 
stones or pulp calcifications while in that state. 

At this point I should stress that individuals may have a 
marked tendency to periodontoclasia as an active process, at 
which time they will have a characteristic physical condition as 
expressed in their blood chemistry, and which physical condition 
may completely change in a few months' time, and they will go 
into a state in which their reaction would be entirely different 
from that which previously obtained. To the casual observer 
so-called pyorrhea pockets would look the same in both these 
stages, yet, pathologically and clinically, they are entirely dif- 
ferent and unlike. This I have discussed in Chapter 28 in Volume 
1. From the standpoint of our present information it would be 
so difficult as to be practically an impossibility to produce the 
same type of results in the treatment of gingival irritations in 
individuals of Group C as those of either Group A or B. 

To illustrate further the difference in the individuals in these 
groups. I have shown teeth from individuals representing Groups 
A and C in Figure 379. The tooth marked A in that figure 
was extracted from the patient whose hand is shown in C of the 
previous figure. Note that the cementum has been thinned down 
to a very thin covering shell and almost entirely destroyed at 
places. This has net been the action of the bathing pus. but is a 
characteristic of all of the teeth of this individual. The roent- 
genographic appearance of her teeth is shown in Figure 378, 
and it will be noted not only that there was extensive periodonto- 
clasia, but that there was a marked characteristic of slenderness. 
In contrast with this 1 have shown in B a tooth from a patient 
who belongs in the class which I have discussed under A of the 
preceding figure, and it will be noted that there has been exceed- 
ingly extensive depositions of layer upon layer of cementum in 
this latter case until the diameter of the root a little distance from 




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CHAP. LXIV SKK1 I 1 \l \NI) Ml'SLTLAR SYSTEM OSTEOMALACIA 245 

the apex is probably approximately lour times that of its original. 
The roentgenographic appearance of this tooth is shown in Fig- 
ure 432, the mesial root of the upper right molar. This patient 
was suffering from very acute eye trouble. It would be a phys- 
ical impossibility for any form of irritant to produce the effect 
shown in B on any tooth in the mouth of a patient from which 
the tooth shown in A was extracted until that patient could be 
changed from the present physical background to that which 
obtained in the patient from which B was extracted. 

We have, therefore, not only the type and quantity of irritant 
to consider, but we have always the type of reaction and charac- 
teristic defensive mechanisms of the host. In Chapters 43 and 
44 of Volume 1, I have discussed the relation of the alkalinity 
index of the blood of these individuals to the ionic calcium and to 
the type of systemic reaction. We must come finally to view 
these patients in terms of their blood chemistries and their ca- 
pacity for metabolic and catabolic processes. The patient from 
whom A was extracted and whose hand is shown in C of the 
previous figure was suffering from osteomalacia. That, however, 
does not mean so much as does the significant fact which is a 
background to her condition — namely, that her alkalinity index 
ranged from 26 down to 20 — and it is not surprising that when 
she, as a seamstress, pricked her finger, she was laid up for weeks 
with a bush-fire type of infection. She is living all the time on 
the edge of a precipice and her safety lies continually in an in- 
telligent effort to restore normality in so far as possible, first by 
reducing the acidosis, and for this, while drugs may be ulti- 
mately called upon for assistance, the diet is, of course, the first 
and most essential factor. 



CHAPTER LXV. 
ALIMENTARY TRACT AND ASSOCIATED ORGANS. 

DISCISSION. 

We are grouping together the lesions of the various organs and 
tissues of the alimentary tract, both because of the biologic classi- 
fication and because our various studies have shown that suscep- 
tibility to the rheumatic group lesions of these tissues seem to 
show a definite relationship between them. For example, indi- 
viduals and their families will frequently show susceptibilities in 
digestive tract only, sometimes as gall-stones, other times as ap- 
pendicitis, both associated with attacks of indigestion not ac- 
counted for by the food, or the latter only. This was illustrated 
in Chapter 2'1. Very frequently attacks of acute indigestion, or 
chronic digestive disturbances affecting either the stomach or the 
large or small intestines, will be associated with acute nervous 
disturbances. We have thought of these as being largely due to 
irritation of the sympathetic nervous system. This view, how- 
ever, does not explain some strange things that have come out in 
our animal inoculations. One of these is illustrated in Case 
No. 965. 

Case No. 965.- This woman, age forty-three, virtually had 
been an invalid for about six years, her affliction expressing itself 
chiefly as nervousness, neuritis, nervous indigestion, associated 
with neuralgic pains at the waist-line. There was marked evi- 
dence of a susceptibility of these tissues from the mother's side, 
as shown in the susceptibility chart Figure 380. The father is still 
living at eighty-four and the father's side of the ancestry has been 
free from rheumatic group lesions. Her mother had died at 
seventy-seven and her mother's father and mother were ninety- 
lour and seventy respectively, indicating that there had been a 
great deal of endurance in the mother's family. The difference 
between the actual conditions and these indicated in the roent- 
genograms was very great. In Chapter 1. Figure 4, we used a 
tooth from this case to illustrate the inability of the roentgeno- 
gram to disclose even an extensive granuloma if it is surrounded 
by a zone of dense condensing osteitis. The complete set of 

246 



Private Records of Weston A. Price, M.S.. D.D.S.. 8926 Euclid Avenue. Cleveland. Ohio 





Form Ni>. 13 Serial No. 

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Figure 380. Susceptibility study showing marked inherited susceptibility from 

MOTHER S SIDE FOR NEURITIS, NERVOUS BREAKDOWN, AND STOMACH TROUBLE. CASE No. 965. 

247 



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CHAP. LX\ \l IMKNIWRV TRACT AND ASSOCIATED ORGANS 249 

roentgenograms is shown in Figure 381. In few cases have we 
found so extreme condensing osteitis as about all these upper 
teeth, all of which were extracted, and all of which had conditions 
very much worse than could be anticipated from the roentgeno- 
grams. Continued low defense for a few years will practically 
always, in this type of case, produce marked condensing osteitis. 
In other chapters, we have discussed the relation of this calcium 
metabolism factor to disturbed defense. Doubtless, most all 
dentists, who do root-filling work, would have concluded, regard- 
ing the tooth shown in Figure 4, that they could safely fill this 
root and that there was no serious periapical involvement. They 
would be overlooking two fundamentals : First, that they are not 
correctly judging the condition about the apex from the appear- 
ance in the roentgenogram ; and unless they have checked their 
work by other means than recording symptoms and comfort on 
the part of the patient, they would not know either their relative 
or actual efficiency in removing the infection from this root. The 
facts are that with the removal of these upper teeth, this woman, 
who had been an invalid for about six years, was so greatly im- 
proved in health, and that very rapidly, that she again took up 
her complete household duties and has had continued good health 
for the four years since these teeth were removed. A culture 
taken from these teeth and inoculated into a rabbit produced an 
acute stomach ulcer with perforation, shown at the point of the 
arrow in Figure 382. Two rabbits were inoculated, both of which 
developed lesions of the digestive tract which was the tissue in- 
volved in the patient. This one died in seven days, the principal 
lesion being this peptic ulcer with perforation. With no other 
treatment this patient gained fifteen pounds in weight in a few 
months' time. In about 1100 rabbits inoculated in the last two 
and one-half years, stomach perforation has not been found in ]/ 2 
of 1 per cent of the rabbits. 

The next case also shows a very marked elective localization 
for stomach tissue. As in the last case, other symptoms so over- 
shadowed the digestive disturbance that the patient did not 
think of that as the chief trouble. This patient's chief affection 
was an involvement of her eyes with marked exophthalmos, not 
her chief eye trouble, however, which was attacks of pain which 
would be so severe that on several occasions a physician had to be 
summoned in the night to give her a hypodermic injection of 
morphine. The paroxysms of pain were so nearly unbearable 
that her health would be injured for days or weeks after an at- 



hl.MM IMIa riONS& DEGENERATIVE DISEASES CLINICAL VOL.11 

tack, which would last for hours, unless morphine was injected. 
This phase of her case is reported in detail in the chapter on this 
subject. However, we wish to note here that the animals inocu- 
lated, as shown in that chapter, developed both rupture of blood 
vessels in the eyes and marked exophthalmos, as shown in the 
photographs. Three of the rabbits inoculated with the strain 
taken from her mouth developed very unusual and extreme lesions 
in the digestive tract with perforation, or near perforation; while 
several others, developed very acute colitis, dying from the in- 
flammatory process of the digestive tract. Figure No. 383 shows 
the viscera from all of the three rabbits. A shows a complete per- 
foration of the stomach and contiguous diaphragm with a bolus 
of food penetrating the rupture into the thorax. B, when posted, 
had such an extensive ulceration of the cardiac end of the stomach 
that it was almost ready to perforate. C shows an ulcer of the 
colon also nearly perforated. 

It is very significant that, whereas 69 per cent of the rabbits 
inoculated with the cultures from this patient's teeth, developed 
lesions in the digestive tract, and in many instances in several 
tissues of the digestive tract, and, whereas, 62 per cent of these 
rabbits developed eye lesions, the percentage of rabbits develop- 
ing lesions of the digestive tract in the group shown in Chart 143, 
Chapter 22, "Summary of Animal Reactions and Patients' Symp- 
toms," which is a miscellaneous group involving affections of all 
kinds, including the stomach, was found to be 36, and in the group 
where the chief lesion of the patient was rheumatism, the per- 
centage of digestive tract lesions is 18. 

The marked improvement in this patient's health has empha- 
sized the need of greater care in the study of the relation of old 
chronic periodontoclasia pockets to health. This patient at one 
time had had acute periodontoclasia, or pyorrhea alveolaris. 
which responded well to treatment; and she thought the disease 
was cured. At the time of her active reaction, visible pus was 
present about these teeth. This completely disappeared. The 
condition of the teeth is shown in Figure No. 439; and, in several, 
pulps were found degenerated and infected. Some of the old 
periodontoclasia pockets had necrotic bone and furnished a bad 
type of focal infection, the original active local reaction having 
entirely ceased, which, if present, would have protected the pa- 
tient. The lower left first molar had a degenerated and infected 
pulp. Very slight evidence of it is shown in the roentgenogram. 




251 



252 DENTAL INFEC1 [ONSfl DEGENERATIVE DISEASES C LINK M- VOL. II 

The patient had such great relief from the removal of the first feu- 
infected teeth, expressing itself both in the absence from the at- 
tacks of acute pain and the reduction in the bulging of the eyes, 
that she became desperate in her determination to have all of her 
teeth extracted. Finally all of the uppers were extracted and 
such of the lowers as were found to be abnormal, both in the re- 
actions of the pulp and the health of the supporting structures. 
In approximately two years, she has not had one single attack of 
the pain in her eyes. She had a few very slight ones during the 
early period while the teeth were being extracted. Her general 
health and digestive function are greatly improved. I question 
if all of the gifts of the world could induce this woman to have 
these teeth back. The remarkable change in the appearance of 
her eyes and the effect upon the rabbit's eyes should be read in 
connection with this chapter by turning to Chapter 66. 

One of the most common of the disturbances of the digestive 
tract is the group affecting the gall-bladder and duct. There may 
be many contributing factors in the production of cholecystitis 
and cholelithiasis. A striking illustration of this is shown in 
Case No. 1048. 

Case No. 1048. — This patient had been suffering from pain 
and nausea for which she had been advised to go to the hospital 
for operation. A lower molar tooth, with very marked condens- 
ing osteitis, as evidenced at the time of extraction, was removed 
and cultured and the organisms inoculated into rabbits. The 
effect on the patient of the extraction of this and two other teeth 
was that the distress of the gall-bladder quite rapidly disappeared. 
She soon gained twelve pounds in weight and for two and one- 
half years since the removal of her dental infection has had no 
return of the digestive and gall-bladder symptoms. The effect of 
the inoculation of this culture into rabbits is shown in Figure 
No. 384. It was to produce a very acute inflammatory involvement 
of the gall-bladder. It was enlarged and distended with a purulent 
fluid found to contain a strain of streptococcus similar to that 
inoculated, and the wall of the gall-bladder had a great many 
little ulcers, also shown in Figure 384. This rabbit also developed 
acute appendicitis, as shown in Figure 385, and a very unusual and 
remarkable lesion, an inflammatory invagination of the cecum 
into the colon, shown also in Figure 385 at B. 

We have had many very striking illustrations of appendix and 
gall-bladder involvement and their relief by the removal of in- 




Figure 384. Multiple abscesses in the wall cf the gall-bladder of 
A rabbit, produced by inoculation with the culture from a tooth of 
a patient scheduled for gall-bladder operation. Symptoms entirely 
disappeared after removal of dental infection. No return of symptoms 
in two and one-half years. case no. 1048. 

[chap, lxv — ALIMENTARY tract and associated organs.] 



253 



Ul\]\ LXV ALIMENTARY TRAC I t, \LI.-HI ADDER 



255 




| 



' 



I 



X 



Figure 385. Digestive tract involvements of rabbit of previous figure: 
A, non-vital molar; B, gall-bladder involvement; C, acute appendicitis; 
D, AN inflammatory invagination of the cecum into the colon. 

fected teeth. In one of these, Case No. 445, the patient was sup- 
posed to be dying from heart lesions. After she had been in ex- 
tremely low condition for some weeks, she was taken with acute 
pain in the bile duct, tenderness over the liver, followed by the 
passage of a number of gall stones, after which her condition very 
rapidly improved. This condition repeated, though not quite so 



DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.H 




Figure 386. Serious dental infections with little local evidence, which contributed to a 

VERY SEVERE CHOLECYSTITIS. CASE No. 1 1 j. 

severely, three times in about as many years. We finally removed 
several infected teeth, one of which is shown in Fig. 386 and which 
we have previously illustrated in connection with Chapter 3. 
This central incisor had a putrescent pulp which was not dis- 
closed by the roentgenogram. For two and one-half years she 
has had no return of either the heart or gall-bladder disturbances, 
and is again doing her household duties, and apparently in 
splendid health. Her factor of safety is, however, small. 

Case No. 525. Some years ago, when I also was in the vigor of 
a mistaken confidence of my ability as an operator, and because I 
thought I could mechanically cleanse canals and could mechani- 
cally make restorations that were both serviceable and comfortable 
and therefore presumably safe, I undertook to repair a number oi 
infected teeth for a patient who was loath to give them up. and 
particularly so. since they were so comfortable and efficient for 
mastication. The courage of a mistaken confidence is not less 
than when it is correctly placed. During one year while repairing 
this man's teeth, he had approximately twenty attacks of appen- 
dicitis; and on two occasions, arrangements were made to rush 
him to the hospital for removal of his appendix on nights follow- 
ing dental operations of the day before for treatments of his 



CHAP. LXV ALIMENTARY TRACT— APPENDIX 25'J 

teeth. During these months his appendix was so tender that it 
was painful and difficult for him to ride in an automobile. Fortu- 
nately, I discovered this relationship between his reactions and 
my operations, though they were not suspected by either the 
physician or the patient. We decided to remove the infected 
teeth. This entirely removed his appendix trouble and there has 
been no further suggestion of need for operation. This incident 
happened about fifteen years ago. Later, when he developed a 
questionable dental condition, he was suffering from a neuritis. 
In order to test a possible relationship between the dental condi- 
tion and his neuritis, we purposely stirred up the infection 
slightly and did nothing else. For a week he was not able to put 
on or take off his own coat. The tooth was extracted and his 
neuritis promptly cleared up and has not returned. 

Still another case of digestive tract lesion is particularly in- 
structive. This patient had been suffering for years from gall- 
stones. On several periods she had gone to the hospital for treat- 
ment. We started to treat her teeth and she was not able to come 
to the office for a day or two because of an acute attack of inflam- 
mation of the gall-bladder. We decided to extract the teeth, 
which we did. This was followed that night by a very acute at- 
tack of pain in the gall-duct, requiring medical care, and arrange- 
ments were made for surgical interference. Within twenty-four 
hours, she passed fifty-two gall-stones. We, accordingly, re- 
moved all infected teeth. While this woman had not had a month 
for five years in which she had not had some trouble, (sometimes 
extremely severe, putting her in bed,) prior to the removal of 
those teeth, she has not had a single severe attack and very few 
symptoms in the six years that have intervened since. Figure 387 
shows the condition of the teeth in this patient's mouth. The 
condition, however, as is so often the case, was worse than would 
be interpreted from the roentgenograms. Note the open canals 
above crowned teeth, with very slight apical absorption in cen- 
trals, lateral, and upper right first bicuspid. The apical reaction 
is much less than should occur with this quantity of infection if 
an adequate quarantine is being maintained about the tooth. In 
this case, as in all this type, the absence of this adequate local 
reaction means the absence of apical absorption of bone and the 
passage of this infection beyond this first natural barrier to all the 
tissues of the body, with the result that the most susceptible tissue 
breaks, in this case the bile bladder and duct. 



258 DENTALINFEC fIONS& DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 387. Roentgenographs appearance of dental infections of a 

PATIENT SUFFERING FROM CHRONIC CHOLECYSTITIS. FOLLOWING EXTRACTIONS, 
PATIENT PASSED FIFTY-TWO GALL-STONES. 

INTESTINES. 

Of the disturbances of the digestive tract, probably none are 
more frequent or so obscure as to their etiology, than are the dis- 
turbances of the large and small intestines. Time after time, we 
have had as part of our patient's history the development of very 
acute diarrhea or constipation, preceding or following the treat- 
ment of dental infections. These symptoms relate to gingival 
infections as well as to apical involvements and they take on an 
entirely new interest and meaning in the light of our animal inocu- 
lations, since so often similar disturbances are produced in experi- 
mental animals. They are of interest also because the patho- 
logical changes produced by each animal inoculation with the 
organisms grown from the tooth culture, and from the toxic sub- 
stance taken from teeth, are so similar to changes produced in the 
viscera by various types of deficiency diets. In the human, dental 
infections may produce many phases of intestinal disturbance; in 
some subacute colitis, acute colitis, a spastic condition of the 
bowel, acute or chronic constipation, which symptoms may be 
very markedly or completely relieved by the elimination of the 



CHAP. LXV ALIMENTARY TRACT INTESTINES 259 

dental infection. These symptoms are frequently very definitely 
related to the nervous system, as is illustrated by the following 
case. 

Case No. 752. — I was called to the hospital to see this patient 
by the physician in charge. He was in bed with a very acute 
neuritis and suffering from a constipation which was exceedingly 
persistent. According to his history, he had been in a hospital 
in a neighboring city for several months with a previous attack of 
acute digestive tract disturbance and constipation that was ex- 
ceedingly resistant to treatment. The roentgenograms of his 
teeth are shown in Figure 388. The history of the dental condition 




Figure 388. Dental infections related to intestinal stasis and neuritis. Case No. 7o2. 

is as follows : The lower right first molar had been crowned thir- 
teen years previously, and from its history and the roentgeno- 
gram, had been abscessed all these years without fistula. The 
upper right lateral had a putrescent pulp with a small area of 
apical rarefaction. There was a history of tenderness thirteen 
years ago following filling, but none of late years. It has not had 
a fistula. The upper left first bicuspid with an old root filling 
shows a periapical involvement. There was a history of tender- 
ness following root filling. The striking feature about his case 
was that with the removal of the upper right lateral, the upper 
left first bicuspid, and the low r er right first molar, there was a com- 
plete clearing up of his neuritis and of his acute constipation. 
Whereas this patient had suffered continuously for three years 
previous to the removal of this dental infection, and at times with 
extreme severity, the effect of the operation was greatly to 
relieve him. A year or two later he had another attack of colitis, 



Private Rt-cuiiK of W. -.Ion A Price, M.S., D.D.S.. 8926 Euclid Avenue. Cleveland. Ohio 

RESISTANCE AM) SUSCEPTIBILITY CHAR1 



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''"■' K1 389 Si mi PTIBILITV Ml Dl OF PREVTOl S( VSE, NO. 752. NOTE FIVB C ISES OF ICUTE 
STOMACH INV01 VEMEN1 ON FATHER'S SIDE, WITH two DEATHS. 

260 



CHAP. LXV ALIMENTARY TRACT— STOMACH 261 

following an empyema of the antrum, which cleared up with the 
clearing of his nasal infection, and he is again in good condition. 
This illustrates how with a susceptible tissue there is a tendency 
to involvement of that tissue, regardless of the source of focal 
infection. In this case, the type of dental infection was a series of 
three locked areas. 

A study of his resistance and susceptibility chart is of particular 
interest. His acute neuritis and digestive tract disturbances, in- 
cluding the acute appendicitis, have all developed since the 
establishment of the definite history of these dental infections, 
two of which, as shown in the last column, date back thirteen 
years and one six years. About one year after the establishment 
of his dental infections, or twelve years ago, he developed an 
acute appendicitis; and three years ago, his chronic constipation 
became very severe and he began a series of hospital sojourns with 
digestive disturbance and neuritis, the last of which was so acute 
as to put him to bed. He was not able to raise his hands from the 
table, so great was the motor involvement. The striking thing 
about his chart, shown in Figure 389, is that his father died at 
fifty-six of acute digestive tract disturbance, both his father's 
father and mother had digestive tract disturbance, and two of his 
father's sisters also died of acute digestive tract disturbance, one 
at forty and the other at fifty. Note that he is developing these 
lesions severely at, and prior to thirty-two years of age. The 
history of these cases is so often that it develops early in the suc- 
ceeding generations where very marked in the ancestry of one or 
both sides. There are, in this family, five cases of, and three 
deaths from, digestive tract disturbance in the immediate rela- 
tives of his father's side. This is a striking illustration of the in- 
heritance of the weak link in the chain and of the involvement of 
that weak link when a dental infection exists. Note the absence 
of lesions in other tissues of his and of other members of his 
family. Another very striking thing about this case is the absence 
of a tenderness of the teeth and of fistulse ; and the suggestion of 
an earlier rarefying osteitis of a very moderate degree. Nature 
was not making an adequate effort in establishing the quarantine 
about these teeth, and the toxic substance plus the bacterial 
invasions were entering his system and causing a break in his 
susceptible tissue. 

There are types of intestinal disorders which very strongly 
suggest that they are sensitization processes. The patient's 











I'K. I Rl 3! \\ 1 NORMOI - MANDIBU1 \K iV--T WITH MARKED DISP1 U I Ml \T OF THIHH MOLAR, 
M \KI V IX) NECK OF CONDYLOID PROCESS, PRODI CING COLITIS, t ISE No. 1019. 



CHAP. LXV ALIMENTARY TRACT -INTESTINES 263 

symptom may be an obstinate diarrhea which may have a periodie 
cycle of recurrence. We have suggested such a case in Chapter 30 
on the Nature of Sensitization Reactions. In this case the 
source of infection was from periodontoclasia pockets. Similar 
and very distressing disturbances may be produced by the toxic 
poison from dental cysts. The following is an illustration. 

Case No. 1019. — The patient had a very large and very unusual 
mandibular cyst, shown in Figure 390, A and B. (See great dis- 
placement backward and upward of the third molar. Note both 
views.) She had been having both nervous symptoms and diges- 
tive disturbances. A drop of the cyst material was aspirated with 
a hypodermic for microscopic study and culture. It contained a 
few organisms and had an abundance of cholesterol crystals. For 
twenty-four hours before the operation on this cyst, the patient's 
bowel movements occurred on an average of about thirty minutes, 
with some griping. At the time of operation, some of the cyst 
material was inoculated intravenously into a rabbit and it de- 
veloped an acute diarrhea in about forty minutes. Four rabbits 
were inoculated. All four developed acute colitis; three developed 
rheumatism and liver involvement; two gall-bladder, and one 
stomach involvement in addition. The patient was also suffering 
from marked rheumatic lameness in her right shoulder. With a 
thorough irrigation of the cyst chamber and packing for a few 
days to keep the air from the sensitive structures, particularly the 
exposed inferior dental nerve, and the removal of the third molar 
which, as shown, had been pushed backward and upward by the 
cyst, entirely out of its normal position, the patient's intestinal 
symptoms entirely disappeared and in two years have not re- 
curred. 

The surgical removal of this tooth was a matter of very great 
difficulty, since the width of the tooth was greater than the thick- 
ness of the ramus. It was accomplished, however, under local 
anaesthetic, with the aid of specially designed and constructed 
instruments with which I moved the tooth down and forward 
through the opening in the anterior border of the ramus, while 
the lateral walls of the ramus were distended to make possible the 
delivery of the tooth. The method of treating was to allow the 
mucous membrane of the mouth to extend into the cyst chamber, 
and the patient was provided with the means for the irrigation, 
twice daily, of the chamber. If these cysts close over before the 
pyogenic membrane is displaced with the normal mucous mem- 
brane of the mouth, they tend to recur. This premature closing 



264 DENTAL IM! a l [0NS4 DEGENER \ll\h DISEASES CLINICAL VOL. II 

is prevented by frequently changed light packings in the orifice. 

It is, of course, impossible to determine, with certainty, the 
degree of the specificity in a given case of apparent elective locali- 
zation. Some very striking conditions have appeared in our ex- 
perimental animals. In general, elective localizations tend to be 
much more frequently expressed when cultures are grown quickly 
and the desired quantity injected intravenously, using as young 
generations as possible in order that the influence of the new 
medium may not have destroyed these qualities. We have, 
accordingly, found that when teeth are implanted beneath the 
skin, they tend to produce such grave changes in the morphology 
and chemistry of the blood as to overwhelm the animal before 
clear cut localizations appear. Notwithstanding this fact, many 
of these animals develop involvements of special tissues, an illus- 
tration of which is the following case: 

Case No. 1353. — The patient, forty-nine years of age, was 
suffering from sleeplessness, general nervousness, and an abdom- 
inal distress that was giving him much anxiety since it had de- 
veloped near the site of the operation for an appendectomy. His 
dental conditions included several quite badly involved, deep 
periodontoclasia pockets, with some apical involvement. The 
second molar, shown in Figure 391, was implanted beneath the 
skin of a rabbit which died with acute appendicitis. The tooth 
was planted under the skin of another rabbit which also died 
with acute appendicitis. The appendices of these two rabbits 
are shown in Figure 391. But this is not more striking than 
the fact, that with removal of his dental infections, his abdominal 
distress and pain disappeared and has not recurred for many 
months. It is my interpretation in the light of my present 
knowledge that the infected tooth placed beneath the skin 
furnished both toxin and bacteria which invaded his body and 
which localized in tissues similar to those already sensitized in 
the patient's body. 

I have shown in the Chapter on Circulatory System, a rabbit 
that was given one inoculation in the margin of the ear vein, con- 
sisting of about 1 cc. of a twenty-four hour broth culture grown 
from the root of a tooth of a patient suffering from acute rheuma- 
tism and which developed acute rheumatism resulting in defor- 
ming arthritis. This rabbit lived for approximately two and one- 
hall years, was crippled, and moved about like an old man with 
typical deforming arthritis. His toes were turned in and he 



CHAP. 1 XV ALIMENTARY TRACT APPENDIX 



265 






.1085 



Figure 391. Acute appendicitis produced in two rabbits in succession by planting of same tooth 
beneath the skin, taken from patient suffering from pain in vicinity of previous appendix operation. 

walked on the sides of his feet. When this rabbit died, it was 
from a streptococcal peritonitis with extensive adhesions. The 
joint involvements had, apparently, been walled off and except 
for the deformity were quiescent. I refer to this case as a sugges- 
tion, and perhaps an illustration, of how infections, that have 
become walled off or focal in the system, may develop extensive 
adhesions by their secondary involvement of peritoneal tissues. 



266 DENTAL INFEX TIONS& DEGENERATIVE DISEASES C LINK AL VOL. II 



A 




Figure 392. Internal and external appearance of acutely 
involved appendix of a rabbit with tooth implanted beneath it?, 

SKIN, FROM CASK No. L346 SUFFERING FROM A DIGESTIVE DISTURBANCE. 

It is. therefore, not improbable that this may have been the 
nature of the disturbance that was going on in this patient's body, 
expressing itself as pain quite typically like the postsurgical adhe- 
sion distresses following appendectomies and other abdominal 
operations. I would also stress that we may haw here one of the 
etiological factors in the various adhesions that develop in the 
abdominal tissues. 

Another case which is also very striking is the following: This 
patient. Case No. 1346, had a very serious physical break, becom- 
ing progressively worse for three years, until he was practically 
incapacitated for duties. The chief expression of his. difficulty 
was pain about his heart, particularly after eating, so severe that 
he could not walk a block, and he even avoided the exertion of 
conversation for some time after eating. He had had many ex- 
aminations, and the interpretation had been that he was suffering 



CHAP. LX\ ALIMENTARY TRACT STOMACH 267 

from myocarditis with a digestive involvement. He had been put 
Oil a very rigid diet. We have discussed his case from the cardiac- 
standpoint in the Chapter on the Circulatory System, and re- 
corded there the most remarkable improvement he made follow- 
ing the removal of his dental infections and special treatment, 
which latter was outlined in Chapter 22 on Elective Localizations. 
I have shown how there seemed to be a relation between the fact, 
that he had a most obstinate secondary recurrent hemorrhage 
following his first extraction, and the development of spontaneous 
hemorrhages in a large group of rabbits inoculated with the cul- 
ture grown from his teeth. The point of special interest here is 
that when one of his teeth was planted beneath the skin of a 
rabbit, it died with a very acute appendicitis. Internal and ex- 
ternal views of this appendix are shown in Figure 392. One of the 
rabbits inoculated with the culture, the one receiving the young- 
est culture, therefore retaining most largely the specific qualities 
of the organism, developed in addition to the extensive spontane- 
ous hemorrhages, of which it died in twelve hours, hemorrhages 
into the muscular coat of the stomach, one of which already 
showed signs of necrosis, which was clearly not a postmortem 
change. This is shown in Figure 393. 




Figure 393. Stomach ulcer produced in rabbit by tooth implantation, 
Case No. 1346 with stomach involvement. 

We cannot pass the chapter on the digestive tract disturbances 
without discussing another type of disturbance of the digestive 
tract which is perhaps the most dreaded enemy of mankind: 
namely, cancer of the stomach. In Chapter 31, on Precancerous 



268 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL II 



Private Records of Weston A. Price. M.S.. D.D.S.. 8926 Euclid Avenue. Cleveland. Ohio 






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''"■' jJJ :; " : ^ REMARKAB1 I INS! WU OF INHERITED St SCEPTIBILITY FOR STOMACH INV01 VE- 
MENT. NOT! SIX OI PATIENT'S IMMEDIATE KM VTIVESSl FFERED FROM SAME, WITH THREE DEATHS. 



CHAP. I. XV ALIMENTARY TRACT AND ASSOCIATED ORGANS 269 

Conditions, I have presented evidence which suggests to me some 
form of anaphylactic reaction of tissues of various parts of the 
body, particularly the skin, which seemed to be related to pre- 
cancerous conditions, and in which the exciting antigen is, in cer- 
tain cases, a toxic substance of dental origin. I have, in that 
chapter, referred to the fact, that cancers of the stomach, as 
suggested by Dr. Charles Mayo, seem definitely to be related to 
the scars of stomach ulcers, and also to the fact, that in our sus- 
ceptibility studies of patients and their families I have found that, 
by selecting out only the cases where the records seem complete 
enough to justify some conclusions, cancers were four times as 
prevalent in the group with an absent or acquired susceptibility 
as in the group with a streptococcal inherited susceptibility, and 
that this corresponds with the groups in which we find practically 
all of our cases of sensitizations. In Figure 394, I present a strik- 
ing resistance and susceptibility chart. This patient, age thirty- 
nine, presents with acute digestive tract disturbance. He has four 
brothers, one of whom is similarly affected. His father is simi- 
larly affected. His father's father and his father's brother were 
similarly affected and died of cancer of the stomach. His father's 
mother has stomach disturbance and his mother's mother died of 
acute stomach involvement. In other words, we have, in this 
family, seven cases of acute stomach involvement, three termi- 
nating in death and two distinctly as cancer of the stomach. I do 
not interpret this to mean that cancer of the stomach, as such, is 
inherited, but that a type of susceptibility to sensitization reac- 
tion has been inherited, and, further, that the defensive elements 
of the stomach itself, have, by inheritance, been defective, tending 
to determine the site of the localization of the sensitization. I do 
not present this as based upon sufficient experimental data to be 
ready for acceptance, but as the simplest explanation of the 
phenomena I am here presenting. 



CHAPTER LXVI. 
NERVOUS SYSTEM AND SENSE ORGANS. 

DISCUSSION. 

It is quite remarkable to me that notwithstanding the fact, 
that I have been making an intensive study of oral infections and 
their systemic expressions for over twenty-five years, nearly all of 
the involvements of the nervous system escaped me during the 
early part of this period, and this notwithstanding we now find 
more disturbances of the nervous system than of any other type 
of tissue. One of my early cases in which I found an unmistakable 
connection was as follows : 

Case No. 110. — The patient, then about fifty years of age, was 
suffering from an involvement of the muscles of the side of her 
neck, a type of torticollis, though differing in that the spasm was 
not constant. She stated that her only recognition of the develop- 
ing involvement was that in church she could not keep her head 
from going over sideways and was compelled to brace it with her 
hand to keep it upright. It was not rotated as usual. She went 
to a photographer to have her picture taken and he was compelled 
to support her head to keep it from gradually going over to the side. 
This involvement was on the left side. After studying her case. I 
condemned the lower left second bicuspid shown in Figure 395, 



Figure 395. A dentai infection which produced a 

TIPPING OF THE HEAD, COMPLETELY RELIEVED BY THE EX- 
TRACTION OF THE BICUSPID. CASE No. 110. 



which, as will be noted, had a very marked condensing osteitis 
and which, of course, I did not understand and appreciate at that 
time. With the removal of this tooth, her trouble was entirely 
corrected. 

Compared with the information available at that time, we 
have learned that there are very many disturbances of the nervous 









B 



\ 







Figure 396. Four rabbits were inoculated with the culture from the tooth 
shown in d, three of which were completely paralyzed from the centers of 
their spines backward, as shown in a, b, and c. patient suffered from spasms. 
Case No. 1001. 

271 










mm 



Figuri 397. Paralyzed rabbit, A and B. C, w ulcer on 

1W1 R SI RJ \C\ "1 ITS Bl Al'M R, SHOWN IN NEXT FIGURE 



■J 72 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS CENTRAL 273 

system, both motor and sensory, and particularly of the neck and 
shoulders; but compared with the great amount of information 
that is needed, we yet know but little. As stated in the Chapter 
on Skeletal and Muscular System (Chapter 64) in discussing neck 
involvements, our histopathological studies of lesions produced in 
animals revealed marked lesions in both the muscle and nerve 
tissues, not always in both and the same case ; and in no part of 
our work has our animal inoculation part of the study thrown so 
much direct information as in the study of the lesions of the nerv- 
ous system; nor could evidence of elective localization be much 
more marked than in some of these cases. This is strikingly illus- 
trated in the following case. 

Case No. 1001. — This patient was suffering from disturbances 
of the central nervous system, which expressed themselves with 
loss of both motor and sensory control for from a few minutes to 
half an hour, followed by a marked interference with motor con- 
trol for several hours. This disturbance was so severe that she 
was compelled to give up her position. The attacks were becom- 
ing more frequent. The lower left first molar, shown in Figure 
396-D, was condemned. Note a distinct zone of condensing 
osteitis apparently surrounding a zone of rarefying osteitis, 
which condition indicates to me both a considerable amount 
of infection and a very inadequate reaction in the tissue 
surrounding the tooth. This patient is not, while in 
this condition, producing an adequate quarantine about the 
tooth for her self-protection. This tooth was extracted 
and with much difficulty, owing to this condensing osteitis. 
This type of socket tends always to be slow in healing, 
as we have discussed elsewhere. Cultures taken from this tooth 
were inoculated into four rabbits, and three of them were com- 
pletely paralyzed from the center of their bodies backward, in- 
cluding sphincters, abdominal muscles, and sciatics. Both motor 
and sensory groups were affected. These three rabbits are shown 
in their living state in Figure 396. They did not lose, seriously, 
in weight ; their appetites were good ; and they kept well nourished. 
They dragged their hinder parts as though they did not belong to 
them. There was no control of urine or faeces. The rabbit shown 
in 397-A is shown in dissection after being chloroformed in 
Figure 398. Very marked lesions were found in the spinal 
cord and sciatics, both within the spinal column and outside, 
shown in Figure 398-D. The bladder of this rabbit was found 
to contain about twenty times the normal amount of urine, 










FIGURE 398. Sill 01 LESION IN SPINA] NERVES IN D E ITHE PARALYZED BLADDER TWENTY TIMES 
NORM \I. -I/I 



274 



CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS— CENTRAL 275 

'S. ft ' 




% 




?> 







Figure 399. Photographic appearance of ventral surface of spine, 
with one destroyed cartilage. 

being enormously distended. Apparently the same strain of 
organism that was grown from the tooth and inoculated into the 
rabbit was abundant in the bladder. The internal surface of the 
bladder showing a very large ulcerative area is shown in Figure 
397-C. The ulcers on the inner surface of the bladder are 
shown in Figure 397-C . The complete relaxation and helplessness 
of the hinder parts of the rabbit are shown in the two views of 
397, which were the normal positions before posting. The rabbit 
shown in Figure 400-C is also shown in section in Figure 400-B. 



4^ 






i-'n.i re 100. Another paralyzed rabbit of thi- serii s. \. roentgenographk appearance of spine. 

NOT! CONDENSING OSTEITIS B COMPRESSION OF SPINAI CORD BY PROLIFERATIVE OSTEITIS C, EXTERNAL AP- 
PE \K\\i 1 OF RABBIT. 

276 



CHAP. LXVI -NERVOUS SYSTEM AND SENSE ORGANS -CENTRAL 277 

C shows a definitely developed deformity in the spine. Figure 
399 shows a dissection of the spinal column from the ventral 
surface. Note that the second lumbar cartilage is absent, 
there being a distinct lesion in the body of both second and 
third vertebrae. A dissection, exposing a lateral view of 
the spinal cord at this point, is shown in Figure 400-B. 
Note a marked displacement and curvature in the spinal 
column with a compression of the spinal cord at the point 
of the infective process. All nerves, motor and sensory, beyond 
the point of this compression were paralyzed. A roentgenogram 
of this lesion is shown in Figure 400- A. Note particularly, 
as we have called attention to in Chapter 64 on condensing and 
rarefying osteitis, this lesion is not revealed as a zone of rarefac- 
tion, but one of condensation; and with the destruction of the 
cartilage and the involvement of the body of the adjoining verte- 
brae, there is a partial dislocation. We have here an evidence of 
the experimental development of a type of Pott's disease which 
may be analogous to some of those obscure spinal lesions which 
develop in children, many of which are definitely known not to be 
tubercular. 

In many respects the pathology of these animals is very similar 
to that of the rabbit presented in Chapter 64, Figures 347 and 
348. We wish to review that case in connection with the nervous 
system. The intravenous inoculation of this rabbit with the 
culture grown from the embedded root of a tooth of a patient 
that had been bedridden for some years, developed a complete 
paralysis from the center of the spine backward, which, while com- 
plete for both motor and sensory nerves, gradually disappeared, 
leaving the animal with a disturbed gait much like a child who 
has had anterior poliomyelitis. The roentgenograms of this ani- 
mal's spine show very clearly the location of the lesion, as does 
also the dissection shown in photograph in Figure 348. In the 
Chapters on Pregnancy, and Primary and Secondary Sex Organs, 
we have discussed this case because of the very marked nervous 
disturbance that developed in this rabbit which had become ap- 
parently normal, physically, so far as its original streptococcal 
infection was concerned. That overload was sufficient to bring on 
in a very acute form a very marked central nervous system dis- 
turbance, as, for example, with excitement such as the clapping of 
the hands near the rabbit, it would fall over on its side. It be- 
came very emaciated after its confinement, at which time its five 
young died in from a few hours to two days; and the rabbit went 





'A 



• 




i 






!*JLi 






in"! 









/ 




■ 



• « 



• 






t 



B 



Figure 101. Lesions in the cortex of mi brain, rabbit which devei oped acute choreic nervous 

SYMPTOMS, SHOWN IN FlGl RE 347. 



278 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS CENTRAL 279 

into a rapid nervous decline, dying in about a month from termi- 
nal pneumonia. A of Figure 401 shows high power studies of 
the spinal cord and nerve tissues of this rabbit. B shows a 
section of the cortex of the brain. Figure 348 shows a 
roentgenogram of the spinal cord of this case. 

Our many studies on animals have revealed a definite tend- 
ency on the part of the organisms, taken from dental infections 
of patients with central nervous system disturbances, to produce 
nervous disturbances in rabbits and a tendency to rarefying 
osteitis. 

It is probable that very many more lesions of the brain are 
caused by streptococcal infections than are recognized. These 
tend frequently to express themselves with choreic movements 
which, because of their motor expressions are, of course, recogniz- 
able, though their etiology may not be. When, however, brain 
disturbances are of such a type as to disturb function rather than 
motor control, the lesion is probably generally thought of as 
being physiologic rather than pathological; and it now seems 
probable that disfunction of the brain cannot exist without a 
structural pathological counterpart and cause. We, accordingly, 
studied the brain of this rabbit with a great deal of interest and 
detail. The following is the pathologist's detailed histopatho- 
logical study. 

"Rabbit X. Brain Tissue from One of the Hemispheres. 
Microscopic Study. 

"Inverted Ocular. — The section shows an irregularly-shaped piece 
of tissue, stained with a light purplish color. The tissue is some- 
what dense. 

"Low Power. — The section represents brain tissue, where with 
great difficulty can be traced the borders of the gray and white 
matter. The most conspicuous histological finding is the pro- 
nounced vascular reaction, blood vessels and capillaries are 
markedly distended, filled with red cells, intermingled with many 
leucocytes, some of which are in the center, some around the 
periphery. Practically all around the larger vessels and capilla- 
ries, is to be seen a condition of perivascular round cell infiltration. 
In seme cases this infiltration is very pronounced. This vascular 
reaction has its location mainly on the periphery, in the pial mem- 
brane. The same round cell (perivascular) can be seen also in the 
deeper tissue of the gray and white matter. In one location of the 
white matter there is a distinct localized accumulation of round 



280 DENTAL INFEC HONS& DEGENERATIVE DISEASES CLINICAL VOL.11 

cells, a localized abscess, and in the neighborhood of it all the 
blood vessels are markedly dilated, filled with red cells, inter- 
mingled with white cells and around them are many round cells. 
The brain tissue proper shows some fatty changes, fatty degenera- 
tion, granular changes. Throughout the whole brain tissue can 
be seen in small groups of two to four, cells of round cell infiltra- 
tion. 

"High Power.— \u the localized abscess the cells are mostly 
round cells; also throughout the brain substance the cells are 
small round cells. Otherwise, there are the same changes as 
described above. In some localities there are small blood vessels 
that show considerable sclerosis. 

"Histopathological Diagnosis. — Acute leptomeningo-encephali- 
tis." 

RHEUMATIC NEURITIS. 

It is not improbable that the disturbances, functional and 
structural, which we are producing in animals are often parallel- 
ing those in the patients who present to us for study and treat- 
ment. It is for this reason that we esteem very highly the infor- 
mation which we have gained by study of the animal pathology, 
both histological and clinical. This is well illustrated in the fol- 
lowing case. 

Case No. 484.- The patient, male, forty-one years of age, as 
he presented to me eight years ago, had the following symptoms: 
Physically, he was under weight, about five feet nine inches tall 
and weighed only 123 :, 4 pounds, making him 22 per cent under 
weight. One arm was much smaller than the other. This muscle 
atrophy was so marked that he could not lift, and had not for 
about twenty years, five pounds higher than his shoulder, with 
his right arm, while with his left he could lift fifty pounds. He suf- 
fered a great deal from rheumatic neuritis. There was no involve- 
ment of the joints, but much involvement of the muscles and 
nerves. He suffered much from lassitude and had a definite 
heart murmur. His history showed a very unusually severe over- 
load coming to a young man of definite rheumatic susceptibility. 
In midwinter a water main burst in the plant of his employer and 
he worked for two hours in the nearly ice cold water repairing the 
break which threatened to do great damage to the plant. That 
night he was taken with an extremely severe attack of what was 
called inflammatory rheumatism, and from the description un- 
doubtedly involved the spinal and sciatic nerves. Both knees 



CHAP.LXV1 NERVOUSSYSTEM AND SENSE ORGANS— NEURITIS 281 

were drawn up to his chin and remained so for weeks. One arm, 
his left, was flexed against his shoulder. Finally, with extreme 
force, his body was straightened and strapped in that position. 
About a year before this exposure, he had a number of teeth 
treated and filled, roentgenograms of some of which are shown 
in Figure 402. This does not represent their condition at the time 
of the exposure, but their condition as he presented to me eight 
years ago. We extracted several teeth and condemned several 




Figure 402. Roentgenographs appearance of the teeth of Case No. 484; patient suffering 
with rheumatic neuritis and heart, with extreme muscle atrophy. 

others. Another dentist told him that he was foolish to have 
these teeth extracted, that he could drain them and fill them, 
which he proceeded to have done. With the removal of the in- 
fected teeth he made very marked improvement, so much so that 
he could raise 15 pounds above his head, with his atrophied arm, 
and its circumference increased considerably. This improvement 
lasted for about one year; and his old trouble came back gradu- 
ally, but with its former distressing symptoms progressively 
getting worse. He returned to me saying that he was willing now 
to abide by my judgment and wished me to take his case again, 
which I did. With the removal of some more of his infected 
teeth he made rapid and excellent improvement. 



282 DENTAL INFECTIONS & DEGENERATIVE DISEASES C LINK AL VOL.11 

A very important incident happened in connection with one of 
these teeth, the lower right cuspid. We desired to take a culture 
from the pulp chamber before its extraction, for study of the type 
of organisms. This was done by opening the tooth, removing 
some of the contents on a sterile broach and resealing the open- 
ing, and I arranged for the extraction of the tooth at a subsequent 
sitting. The patient returned to the manufacturing plant where 
he was employed. That afternoon he was taken so severely with 
a type of neuritis that drew his right knee up against his body, 
and from which he suffered so severely, that an ambulance had 
to be called to take him to his home. We extracted the tooth the 
following day and the trouble began to improve in a few hours 
and in a day or two had entirely disappeared. This, he said, was 
a symptom quite identical to what he had suffered in his first 
attack. 'With the removal of these dental infections he made so 
great an improvement that for the first time in twenty years he 
was able to use his right arm almost as efficiently as his left, ar.d 
came finally to be able to swing a heavy sledge hammer with it for 
hours at a time without exhaustion. He was making splendid 
progress when he was taken with Flu and developed pneumonia, 
which I presume was probably streptococcal pneumonia and 
which proved fatal. 

Several important observations should be made in his case. 
The structural changes produced in the animals inoculated with 
strains from similar cases and from teeth of patients suffering less 
severe lesions are characteristic. There is a marked tendency to 
localize in the spinal and motor nerves. This man gave a history 
of a great deal of suffering from abscessed teeth at the time his 
dental work was done at nineteen or twenty years of age. There 
is no doubt that much of the infected tissue, shown in Figure 402, 
was present, in part, at the time he had his extreme exposure in 
the cold water at twenty-one years of age. It is not improbable 
that had his dentist at that time carried out a program of preven- 
tion, not building simply for a man in normal exposure and with 
normal resistance, but one for much less than normal defense, as a 
study of his history would have revealed, and had prepared him 
not only for ordinary overloads of exposure but for extreme ones 
such as he got in other words, built a factor of safety that would 
stand rough seas as well as calm this man might have been 
spared his months of agonizing suffering, years of incapacity, and 
premature death; and yet this dentist did just what nine out of 
ten probably of the dental profession of the country are doing 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS— MENTAL CLOUD 283 

today through ignorance. 

In Figure 403, we show his susceptibility chart from which it will 
be seen that his chief trouble was rheumatic neuritis, and lassitude 
with heart involvement; that he had a definite inherited suscepti- 
bility to rheumatism and neuritis from his father's side and to 
heart from his mother's side, his mother having had heart involve- 
ment quite severely though she died suddenly, presumably of a 
stroke. The mother's brother died of heart involvement. A 
brother and two sisters have all had rheumatism, and a sister has 
had a serious heart involvement and two of her sons have had 
very severe heart involvement. He has broken just where we 
should have expected; and the result, in his case, corresponds to a 
large majority of cases with a marked hereditary susceptibility 
plus dental infection and overload. This triad will break any 
human body. The life, at sea in this boat, is sailing in a vessel 
that is safe only in calm waters; and this case represents, proba- 
bly, one in ten of all the patients who come into any dental office. 
When we remember that one in ten of the funerals of all ages is a 
life that has been foreshortened because of heart involvement, we 
are simply recording the fate of a craft that has drifted into 
rough seas, for which its factor of safety is too low. The cracked 
china cup may last longer than any cup in the cupboard, but only 
because it is taken better care of than are the others. 

In this conection, I wish to refer to the affect of a similar ex- 
posure upon our injected rabbits, to which I have referred in 
Chapter 21 on Overloads. These showed that rabbits, that were 
subjected to chilling by having a part of the body submerged in 
ice water for fifteen minutes a day for a few days following their 
inoculation, developed acute purulent arthritis where the con- 
trols receiving the same culture and same quantity, but were not 
subjected to this chilling, did not develop lesions. 

MENTAL CLOUD. 

Cases that will naturally be grouped under central nervous 
system with psychic involvements will include a great number and 
a wide variety of affections. This is so common a disturbance 
that we have found it necessary to make a place on our resistance 
and susceptibility charts for it, and where, lor convenience and 
courtesy's sake, we have termed it "Mental Cloud." We have, 
therefore, discussed this group under that title. 

As indicated in the closing paragraph of the preceding text, we 
had a very large variety of disturbances of which an important, 





Private Records of Weston A. Pric 

RESIST] ANCE AM) 

mnxr Tf.C A/ 

HlKI ss 

IIKI Cb>IPI.AINT-R^ eum ^ 


e. M.S., D.D.S., 8926 Euclid Avenue, Cleveland, 


Ohio 






n No. 1 


, u8 n _ 


2 £ E : 

= I 

- - 


r 


sl 




JSCEFIIBIEITY CHART 

x/8^| A '' 1 Ul 


A 


1) ^" vi--i-/£ . 


v.' 


tic "neuritis. Un.sSi.fcmJ p. Hear', 




= 


Kill 1 M \IH' 1 .Kol P 
I.KSIOXS KM) 

Cl iMI'l.H \ 1 IONS 


< IU N 


I'ATHKBK Sid« 

Z. - = ' = 

5 | i" 7 7 


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: 


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1 










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. 








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1 1 










— ' — i — 

: .'1 : . 1 








a. 


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I'ousillitis 


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- 




Klieuiiialism 


-fe.# L 


** + 














1 • 




Swollen nr Deformed Joints 






* 












«■ 


N'eck-liaclc nr Shoulders 




1 












1 7 








Liinihami 














1 • 


m 


tt 


Neuritis 


H 




* 


1 






a 1 






Sensitizations 












aa 






Sciatica 


* 
















Chorea or St. Vitus's Dance 


*i#Hi 


•e-r'S 








H 


Nervous lireakdown 


* t- \ 












Mental Cloud 










M 




ti= 


Persistent 1 lea<lai he 


* * * 








- 

■a 




m 


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at 




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34 




Kidne) l^esions, rlrights 


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. 




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Appendicitis 


* 
















4 a 




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l'\ e, liar, Skm. Shingles 










43 
44 
43 . 

40 

4 7 

40 
4 O 






Pneumonia 














Anemia 












< ioiter 










#^ 


lassitude, ». i 


-r! 


* 








1 [ardening >>t Vrteries 








5 ■ 


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ffi 


ffXBffi 
















\ge ii l.i\ inj; 








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Age at 1 >eath 




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I'hi w nli Ci miplicati< ms 




















I'ln without Complications 




















H 


Ty p Km ci_ 










« 1 

oa 




























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Rxtensh e 1 1 ■< »t 1 1 1 ii 












00 






Ahscessed Teeth 










7. 






Loosening reeth 














70 




Ke» rop -f- M»o hsiom 


# VtBT S€ve»CLV ^feOPfHATIOM 

+ J Probablv ® Fatal Attack 


1 


7 1 

7 a 
73 





>. IK II -. I.OKII CON I-.N,. -I . Ml. 

II fr *■ * * 

j; l\ KHII I'll S Kl \ IM. K V lie; 



Kill 



|-\KI. KICK KOXI 



SfSC. ,N "' 



Aiisr. sc. xo 



I U'll'K "1 "lllll 
V. II'-. UK. II I UK I <.\\ V.I \\. 



Figure 103 Susceptibility record. Case No. 184. Note the strongly inherited 

SUSCEPTIBILITY TOR III- \KI \\h Kill 1 MATISM, WITH POI R DEATHS PROM STROKE. 

284 



CHAP.LXVI- NERVOUS SYSTEM AND SENSE ORGANS MKNTAL CLOUD 285 

if not the chief expression, is a psychic depression or aberration. 
A very simple and the most frequent expression of this is a sense 
of impending doom and discouragement. In a number of in- 
stances, patients not only did not care whether they lived, but 
struggled with a fear that in these states they would take their 
own lives. In many instances this depression has completely dis- 
appeared after the removal of dental infection. Another and very 
common expression is that of discouragement and a depression 
amounting to gloom, with a reaction, as crying, with little or no 
provocation. The next case illustrates such a condition. 

Case No. 1178. — The patient, age thirty-five, mother of two 
small children, the youngest six or eight months old, has been 
suffering from extreme nervousness, apparently without cause, 
numbness of the hands, digestive disturbance not accounted for 
by food, and pain in the back. These had dated back to a recent 
pregnancy and had been most severe during the period of lacta- 
tion. The mental condition was sufficiently alarming to cause 
her husband and herself much apprehension, and it did not re- 
spond either to rest or medication. Her resistance and suscepti- 
bility chart, shown in Figure 404, and her history indicate that she 
has been breaking very seriously in the nervous system at differ- 
ent periods of her life. The first two columns, showing the present 
and past rheumatic group disturbances of the patient, indicate 
that she has been breaking with unusual severity. Her one 
brother, twenty-nine years of age, has also had several of the same 
lesions. Her father, still living, had a very severe nervous break- 
down at forty-eight. He also has had rheumatism and acute 
digestive disturbance. His father died young, by accident, and 
his brothers and one of his sisters had acute rheumatism and a 
severe neuritis. This patient's mother died at fifty-two, by 
accident. However, she had been troubled severely with gall- 
stones and acute indigestion. Her mother's father died of 
Bright's disease and two of her mother's brothers died of acute 
digestive tract complication. 

The analysis of her case reveals, as types of dental infection, a 
marked tendency to caries, much apical infection, locked area in- 
fection, with condensing osteitis. The sockets were very slow in 
healing. The systemic relief from the removal of the dental in- 
fections was complete; the type of susceptibility, inherited; and 
the factor of safety, low. This patient had had a tendency to 
gingival recession. There was no free pus at this time. The teeth 



Private Records of Weston A. Price. M.S.. D.O.S.. 8926 Euclid Avenue. Cleveland. Ohio 

RESISTANCE AND SUSCEPTIBI1 II V CHART 
p*»«k* S.B.H C^e /Vo //7a age 3v5 - 

AlH.kl SS 

V." 1 1 ii 1 COMPL u\ 



Datk 



. lo, . 4 -\ 
Merr<rs. CrVLYyi. T3a.cka.CrH tti ha.Tld.S 



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ii 



i 



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'-' OWN 



KlII.IM \ IK t .KiH P 

1 . 1 s I < 1 \ •* \ M 1 

Co.MPLIC v riONS 



N... 



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kliiiimatiMii 



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;: 



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\n k-lui k or Shonlilers 



l.'imKtK" R,cbA. 



Neuritis 
Sensitizations 
S« iaticn 



Chorea or St. Vitus's I ' n. e 
N'en otis BreakiloM u 



Mental Cloml 
Persistent 1 Ir.nl.u Ik- 



lli-.irl l.c>i.iii-. 

I (ropsy 

Ki.liKv 1. «."•!< niv I'.ri^ln- 



Li\ it or i '..ill Lesions 
Appendicitis 



Sloniacli pain or Ulcer 



I'm-. Kar >km. Shing le! 
Pneumonia 



Anemia 



t iQiter 

lassitude, Chillim -~ 
I lanlening ol Arteries 
Stroke 



Age il l.i\ ing 



Age at Death 



Pin with Complication; 

nlj 



Pin \\ ithont Complication. 8 



Nei 



,1^SU. 



Til 

3x2 



I . n i 



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Wiscesseil Teeth 



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K«r FOB -f- M»o HSiOM 

CM»«I #FRCQU£NTl» 



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i 



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+ ) P«OB««Lt ©Fatal Attack 



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- 'f '-1KHII I . I ■ I \ K1\IM. Willi.. 



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Kill 



COM P. 

r 



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1MI l. ACi Ilk UW St SO 



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Figum KM Susceptibility record of Case 1178 Note strongly inherited suscep- 

1IHII 11V FOR H.iMKll INVOl VEMENT \M> NEURITIS 



CHAP. I.XVI NERVOUS SYSTKM AND SENSE ORGANS MENTALCLOUD 287 

condemned are indicated and all are shown in Figure 405. We 
would call particular attention to the zone of condensing osteitis 
surrounding the rarefying in the mesial root of the lower left first 
molar and surrounding both roots of the lower right first molar, 
indicating that, previously, there had been a state of relatively 
high resistance which had changed to one which we consider to be 
of less resistance, in which the local reaction took the form of a 
deposition rather than a rarefaction. 

The length of the lines in the two columns, Duration of Dental 
Infection and Duration of Chief Affection, show that the dental 
history indicates that the lower first molars were known to have 
abscessed and been treated when she was fourteen years of age. 
During girlhood her defense was apparently ample to protect her 
against this infection. Her present series of serious breaks began 
with her first pregnancy at twenty-eight years of age. The re- 
moval of her dental infections was followed by a prompt removal 
of all the acute nervous disturbances. In this case there was a 
great deal of dental infection and of a type most likely to be 
serious, as indicated by the condensing osteitis surrounding the 
rarefying. 

Cultures taken from her teeth and inoculated into animals 
produced very marked central nervous system disturbances and 
degenerative arthritis accompanied by other important patho- 
logical changes. 

Rabbit 716, shown in Figure 406, had a very marked disturb- 
ance, including dragging of the hind legs followed by an acute 
painful swelling in the region of the left hip joint. This paralysis 
developed in about three weeks after inoculation with 1 cc. of a 
24 hour culture from the teeth. In about a week's time the 
rabbit began to improve rapidly, but retained deformity in its 
gait with some swelling of the left hip, as shown in the roentgeno- 
gram in Figure 407. The progressive stages of this hip disease are 
shown in the succeeding pictures, A, B, C, etc. The rabbit was 
chloroformed and posted about four months after the inoculation, 
at which time it weighed 1493 grams, a total gain of 378 grams, it 
having weighed at the time of the inoculation 1115 grams, and 
from which weight it reduced to 965 grams at the time of its paraly- 
sis. Figures 408 and 409 are photographs showing the changes in 
the heads of the femurs. Figure 410 shows a smear of diplococci 
taken from the joint capsule. 

Rabbit 710 was inoculated intravenously with 1}4 cc. of a 
twenty-four hour culture of freshly extracted teeth, at which 






V. 



< 
/ 

(- _ 
z r 



u; 1- 
_ — 






CHAP. LX\ I NERVOUSSYSTEM AND SENSE ORGANS— MENTAL CLOUD 289 




Figure 406. This Rabbit 716 carried or dragged its hind leg from a culture from the tooth 
shown on opposite page. see next figure. 

time it weighed 1665 grams. In twelve days, the rabbit was given 
the second inoculation, thirty-two days after which a condition of 
partial paralysis developed in the hind legs. The rabbit with the 
paralysis of the hind legs is shown in Figure 411. Roentgenograms 
of the vertebral column were made and show the condition in 
Figure 412. The weight of this rabbit, when chloroformed five 
weeks after the inoculation, was 14 grams more than when in- 
oculated. The postmortem of this rabbit showed a tumor-like 
mass on the posterior surface of the vertebral column in the 
region of the first and second lumbar vertebrae. The inter- 
vertebral cartilage was completely destroyed and its position sur- 
rounded by a thick fibrous capsule. On opening the capsule, there 
were exposed the vertebral borders bathed in the mass of broken 
down tissue and plasma. The neighboring vertebrae and the 
cartilages were normal. This necrotic suppurative process ex- 
tended into the intervertebral space and involved the spinal cord. 
This rabbit also had a myocarditis and an acute nephritis. The 
paralysis involved the sphincters. There was an acute dilatation 
of the urinary bladder with retention. Motion pictures were 




V SERIES OF^ROENTCl NOGRAPHK V tEWS OF PROGRESSIV1 I>: Ml OPMENT OF HIP DISEASE IN RABBIT 
HOWN IN PREVIOl SFIGURJ CULT! RE FROM TOOTH IN C \M- L178 






1 



I 




Figure 408. Photographic appearance of heads of femurs on posting, Rabbit 716. 




Figure 409. Enlarged views of normal and diseased femurs of Rabbit 716 from 
Case No. 1178. 



291 



292 DENTAL INHa I IONS& DEGENERA1 [VE DISEASES CLINICAL VOL. II 



/ 






Figure 410. A smear showing diplococci in its from 
hip joint of Rabbit 716. 




Figure ill. Rabbit 710, which developed par \i rsis of hind i egs from dentai <.i i tiki-: from Cam-: 1178. 








A 






D 




Figure 412. Roentgenographic appearance of lesion in the spine of paralyzed rabbit, 710. Case 1178. 
A, lateral view while living. Note condensing osteitis. D, C, and B, ventral and lateral views. Note 
condensing osteitis. 



293 



294 DENTAL INFEX I IONS& DEGENERATIVE DISEASES CLINICAL VOL.11 



* 





Figure 413. Smear frcm kidney of rabbit with nephritis from dental infection, mi iwing pus cells 

AND STKKI'TCCOCCI. 

made of this rabbit. A smear from such a kidney is shown in 
Figure 413, showing pus cells and streptococci. 

Rabbit 632 weighed, when inoculated, 1100 grams. It was 
inoculated with a twenty-four hour culture prepared by inoculat- 
ing media with the filtered portion of the washings of the crushed 
teeth. This filter took out all but the extremely small organisms. 
The culture which grew was an exceedingly minute streptococcus 
in diplococcal form. The next morning following the inoculation, 
the rabbit showed peculiar choreiform movements and lateral 
nystagmus of both eyes. The rabbit lost in weight rapidly. In 
eight days it reduced to 822 grams, at which time the head was 
rotated and the choreiform movements were very marked, which 
torticollis developed more markedly until the rabbit's head was 
turned sharplyto the right. It was chloroformed sixteen days 
after the inoculation. The brain and spinal cord were markedly 
engorged, with evidence of a brain and spinal meningitis. Figure 
414 shows sections from the brain and spinal cord of this rabbit. 







I 









B 

* 











* -'* «a 






* 






• 


% 




T 


• 






• 


; 








• 
• • 




* 









* ' 




« 


• 




• 




A 






M 




• 







Figure 414. Central nervous system changes in Rabbit 632 with chorea, nystagmus, torticollis, and 
gyratory movements: a, a focalization in cerebellum of brain; b, congestion and degeneration in gray 
matter of cord. 

295 



296DEN1 M.IMIA [TONS & DEGENERATIVE DISEASES CLINICAL VOL. I] 

Rabbit 630 was injected with the same quantity of the same 
media which had not been inoculated from the filtered washings 
of the crushed teeth, at which time it weighed 1075 grams. It 
was posted in twenty-one days, at which time it had gained 120 
grams, approximately normal growth. No pathology was found 
and in every way the rabbit was apparently normal. This was a 
control rabbit to see whether any other substances than the virus 
from the crushed teeth were involved. 

Rabbit 626 was inoculated intravenously with a suspension in 
normal salt solution made by finely grinding some of the sediment 
from which the filtrate was taken for inoculating Rabbit 625. 
This inoculation was used in part to test its effect in sensitizing 
the rabbit for the culture grown from this sediment; and ten days 
following the sensitizing dose above, the animal was inoculated 
intravenously with 1 cc. of the culture grown from the same sedi- 
ment. Two days later, the rabbit was favoring the left front leg 
and a swelling appeared in the left shoulder joint. Eight days 
later it was chloroformed, at which time it had gained 168 grams. 
The postmortem showed an intracapsular purulent arthritis of 
the right shoulder joint. Note that this is an exceedingly short 
period of time for a culture to produce a purulent arthritis, and 
in the light of the history of similar strains, strongly suggests that 
the first dose, while infinitely minute in actual amount of organ- 
isms conveyed, tended to prepare the animal for the inoculation 
of the strain grown from this source. This is in contradistinction 
to the immunizing effects produced in small but graded doses. 

Rabbit 624 was inoculated intravenously with 5 cc. of the 
filtrate from the crushings of these same teeth: namely, the upper 
right first and second bicuspids. (See Figure 405.) This again 
was a test of the effect of the filtered washings for producing a 
sensitization or preparation of the rabbit for an intravenous in- 
oculation, which was made twelve days later with 1 ' { cc. of a 
culture from these teeth. Seven days later, the rabbit developed 
an acute swelling of the left hind leg and knee region, partially 
carrying the same. It was chloroformed, at which time it showed 
a total gain of 129 grams. 

A very marked and unusual condition is expressed with this 
strain. All these rabbits, though seriously involved, have shown 
gains in weight, quite unlike the reactions produced by ordinary 
strains and particularly all those producing proliferative ar- 
thritis. An associated very important and characteristic symptom 



CHAP. LX\ 1 NERV01 S SYSTEM AND SENSE ORGANS MEN I \l. CLOUD 297 



of this case is that this patient, notwithstanding her extreme 
nervous involvement, was not reduced in weight but was slightly 
over weight. On postmortem, this rabbit was found to have 
ulcerative aortitis and intra- and extra-capsular articular puru- 
lent arthritis of the left knee. Figure 415 shows an aortic arch 



■ 







■ 











Figure 415. Lesions in the aortic arch of Rabbit 422. 

section and Figure 416 a section of the joint capsule illustrating 
this condition. Note that Rabbits 624 and 626 give evidence of 
an anaphylactic arthritis. 

Rabbit 604 was injected intravenously with the filtrate from 
the washed crushings from the lower right first and second molars, 
at which time it weighed 1110 grams. This rabbit went into a 
progressive condition of marasmus and cachexia. It died in 
twelve days from extreme emaciation. Otherwise, there was no 
gross pathology. It had lost in weight 318 grams or nearly 29 
per cent of its weight. Note that this animal lost in weight, 
receiving only the filtered washings of the tooth ; whereas, those 
that received the culture grown from this sediment gained in 
weight. This rabbit did not develop acute localization symptoms 
but, primarily, marked symptoms of a toxemia. It is very evi- 
dent that we are dealing here with two distinct types of animal 
reaction produced from teeth from the same patient. 



29H DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 







« f. 








1 

■ 



i 



J*/ 5 









Figure 416. Typical degenerative arthritis of joint capsule of Rabbit 624. 

Another and very common expression is a disturbance of the 
centers controlling sleep. These disturbances may take any of a 
variety of forms: extreme sleepiness, marked inability to sleep, 
distressed dreams with sudden awakenings, muscular twitchings 
and jerkings during sleep. One of these is illustrated in the fol- 
lowing case: A young man. Case No. 711, age twenty-two, who 
would regularly sleep fourteen hours and then had to be awak- 
ened. Almost immediately there was a change in his condition 
and he was slept out in eight hours. He remained normal in this 
regard when last reported, one year after the extraction. 

Another illustration is shown in Case No. 1273. whose disturb- 
ances were the following: extreme sleepiness requiring fourteen 
hours a day, neuritis in his neck and shoulder, and nervous indi- 
gestion. These symptoms entirely disappeared within a few days 
after the obliteration of the dental infection, so much so that he 
was more rested in eight hours than formerly in fourteen hours. 
The roentgenograph^ record of his dental condition is shown in 



CHAP. I. XVI NERVOUS SYSTEM AND SENSE ORGANS SLEEPINESS 299 

Figure 417. The history showed that this eondition of disturbed 
sleep, nervousness, and lassitude dated back for two and one-half 
years, during which time it had been recurring with increased 
severity, the last attack lasting a month and being very distress- 
ing. One year later the patient reports that he has had complete 
relief from his old trouble of sleepiness. 

Another and more serious expression of disturbance of the 
central nervous system and sleep is illustrated in the following 
case which had been cons dered one of hopeless insanity. This 
patient, age forty-seven, was brought with the history that she 
had not slept for five weeks ; that her previous attacks of insanity 
had been preceded by similar disturbances; and that she had been 
in insane institutions for approximately eight of the twelve 
months of each of the last five years. Her attacks developed in 
the following order: First, sleeplessness developing with in- 
creased severity until she would be awake every hour, day and 
night for several weeks ; extreme excitability and irritability ; and 
finally, violence, in which stage she would be put into an insane 
asylum. The dental condition is shown in Figure 418. Her his- 
tory showed that the upper right central and lateral were broken 
by an injury at twelve years of age and had been suppurated ever 
since, namely thirty-five years. There had been exceedingly 
little local discomfort from her teeth. With the removal of three 
or four of the teeth, the patient slept much of the time for three 
days. The cycle of her developing symptoms indicated that soon 
she would be violent and she was to have been taken to the state 
asylum for treatment, when placed in our care. While giv- 
ing her our attention, we placed her in the private ward with a 
skilled nurse. In a few days' time she passed through the series of 
nervous system disturbances which in previous attacks had taken 
many weeks. After removing her several infections with as much 
care and freedom from nervous overload as possible, she was 
placed in an insane asylum because of the danger to those attend- 
ing her. In about two weeks' time we were notified that she was 
apparently normal and could go home. All previous attacks for 
five years had required, approximately, eight months to recover 
from. She was kept in the institution as an instructor in fancy- 
work for the female patients. Being a highly trained business 
woman, she was transferred to the office where she had the re- 
sponsibility of the director's work for ten hours of the twenty-four 
in an institution with two thousand insane patients. She has had 





300 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS MENTAL CLOl D 301 

no symptoms of recurrence for approximately four years, has 
since been married, and is, as nearly as we can judge, a fairlynormal 
woman. 

Her susceptibility chart, shown in Figure 419, would be inter- 
preted as fellows: The patient's chief trouble has been a type of 
nervcus breakdown with mental cloud as insanity. One of her 
sisters has had several disturbances of the nervous system, in- 
cluding a mild nervous breakdown. The patient's father had 
nervcus breakdown and headaches. The patient's mother had 
symptoms in a mild way resembling those of the patient. While 
she never required to be in the care even of a guardian, she had 
spells of violent anger and was given to nagging and continual 
fault-finding with members of the family, but too shrewd to do so 
in the presence cf outsiders. She died at seventy-two having 
lived alone the last twenty years of her life because of her dispo- 
sition, which made it impossible for her children to live with her. 
Rheumatism was present on the mother's side. This daughter, 
therefore, received by inheritance this marked tendency to nerv- 
cus break from her mother, accentuated by nervousness and 
headache from her father. This phase of her central nervous 
system was a very weak link in the chain ; and in accordance with 
our studies, when such a person has a dental infection, its effect 
is, primarily, to irritate and affect that weakest link. The thing 
that happened to her was just what should have been expected. 
In addition to this, an acquired susceptibility tends to affect the 
nervous system or an injured tissue, chiefly the former. 

As disclosed by the roentgenograms, she had an unusually 
large volume of dental infection; and by volume, I do not mean 
the cubic area of absorption at root apices, but the extent and 
quality of the infected dentin, as expressed in its ability to cause 
reaction in the patient, locally and systemically. If she carried 
root end infection perpetually from the time she was twelve 
years of age until she was forty-eight, it would require an excep- 
tionally high defense to maintain her safety. The absorption en 
the side of the right lateral is an indication of an ability on the 
part cf the patient to make a vigorous reaction during a long 
period cf time. The condensation around these areas would 
indicate that the patient had come to a period sometime previ- 
ously when her local reaction was less efficient. According to her 
history, these teeth were crowned twelve years previously and her 
nervous disturbances began about eight years ago and took on 
their extreme phase five or six years ago. The fact that 



Private Records of Weston A. Price, M.S., D.D.S., 8926 Euclid Avenue. Cleveland, Ohio 

RESISTANCE AND SUSCEPTIBILITY CHART 

1>AT|EK1 CcLse fi*. ss-j s.vr.yy. A " ys 

Address Date i-io iq 

« 
CriiKi Complaint 



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COMPLIC \ THINS 



Tonsillitis 



kheuniali-111 



Swollen or Dciornieil Joints 



t2 .1 



N'eck-hack <>r Shoulders 
Lnmliago 



Neuritis 



Sensitizations 



Sciatica 



Chorea or Si. Vitns's Dance 



Nervous lireakdown 



Mental Ctond qj [^c^ 
Persistent I leadache 



Heart lesions 



1 >ropsy 
Kulnev Lesion! 



Liver or < rail Lesions 



Appendicitis 



Stomach pain or Ulcer 



Eye, Ear, Skin, Shingles 
Pneumonia 



Anemia 



< 'toiler 



lassitude, Chillines 



I [ardening of Arteries 

Stroke 



Age it L iving 
Age at Death 



Fin with Complications 



Phi without Complications 



/.PnTn )q;a, 



^Ty ph.a l d. 

Ex ten si > e Tooth I >ecay 

Vhscessed Teeth 



Loosening I eeth 

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Figure U9. Susceptibility record op Case No 557, with insanity and marked inher- 
ited riBILITV TO NERVOUS BREAKDOWN, tND MENTAl CLOUD. 

302 



CHAP.LXV1 NERVOUSSYSTEM AND SENSE ORGANS MENTALCLOUD 303 

this patient was passing into the series of progressive symptoms 
precisely as the previous attaeks for five succeeding years had 
come on, indicates that the same forces were at work and that 
the patient was reacting in a similar manner. Since, however, the 
long maintained excitement and violent stage were aborted by the 
removal of the infections, so completely that she was reported by 
her brother to be more normal in two months than he had 
seen her for years and was reported to be so greatly improved as 
to come home in two weeks' time, suggests, if it does not indicate, 
that an important contributing factor had been removed in the 
removal of the infected teeth. This, together with the fact that 
she has had no recurrence, puts great importance upon thedental 
infection. 

As for the future, we would say that the same inherited suscepti- 
bility exists and a sufficient overload will doubtless bring about a 
break. It is my opinion that few, if any, overloads are more po- 
tent to bring about such a break than dental infections. Whether 
these act largely or chiefly by bacterial invasion of the central 
nervous system, by toxemia's irritating the central nervous sys- 
tem, or a sensitization as true allergic reaction, or all three, is not 
as yet definitely established. There is strong indication, how- 
ever, that each of these mechanisms may contribute and each 
may be the chief acting force in certain cases. 

We have undertaken to study the effect of the toxic substance 
in infected teeth as a sensitizing agent. We have discussed this 
specifically in Chapter 30. It will be of interest in this connec- 
tion to review the studies of these phenomena where the sensitiz- 
ing substance was taken from the teeth of a patient suffering from 
central nervous system disturbance. The patient, female, mar- 
ried, age about twenty-four, two children, ages about two and 
four, has developed a very striking central nervous system dis- 
turbance expressing itself chiefly in crying without provocation. 
With the removal of her dental infections, these symptoms have 
disappeared. The teeth involved are shown in Figure 420. 
The extent of the areas, as suggested by the roentgenograms, 
particularly the upper right and left laterals, suggests that 
the patient has previously had a good power of reaction. 
The beginning zone of condensing osteitis, forming a boundary 
about these zones, suggests the onset of a period of less effective 
defense. This probably dates back to her pregnancy of three 
years ago. Studies were made to determine the effect upon ani- 




z 




304 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS-MENTAL CLOU I) 305 

mals, both by direct inoculation and by sensitization with filtered 
washings from the infected teeth. The effect of the extractions 
was to improve, greatly, the nervous disturbances. 

Lesions of the brain, being in a tissue that does not readily re- 
construct destroyed functioning cells, of necessity leave an en- 
tirely different type of scar or after effect from a lesion in muscle 
or even bone tissue. Patients suffering from a toxic or bacterial 
irritation of central nervous system tissue, brain, or cord, for a 
period of many months or a couple of years, tend readily to 
develop permanent lesions. When these affect certain areas of 
the brain, the only apparent lesion may be as a psychosis. Such 
individuals are termed queer or insane in accordance with the 
degree of that disturbance. These lesions may have a large range 
of expression, and it now seems probable that a very large num- 
ber of the inmates of our insane asylums are simply illustrations 
of the effect of a too long maintained focal infection, the toxic irrita- 
tion of which tended to select brain tissue, with the result of a per- 
manent functional, and though ultramicroscopic, a permanent 
physical injury. To extract the infected teeth causing this condi- 
tion after this permanent scar in the brain tissue has been estab- 
lished, should not be expected to cure this extreme disturbance 
because this tissue does not repair. The appeal of so many of the 
readers of our dental profession that dental infections that they 
presume to be slight are doing no harm and should not be dis- 
turbed until the patient shows evidence of a physical injury, is in 
many cases delaying the surgical interference which might pre- 
vent a permanent brain lesion, beyond the time when repair is 
possible. The prevention of the serious and permanent central 
nervous system disturbances, such as the insanities, can only be 
accomplished by the removal of the dental infections before the 
central nervous system tissues are seriously injured. Preventive 
measures, as a prophylaxis for these individuals, should be accom- 
plished before the trouble begins. Teeth that are potentially 
capable of furnishing a focal infection are of danger to this type 
of patient, not so much in proportion to the quantity of that infec- 
tion, as in the predisposition to the involvement of brain tissue. 
Hence all patients should have as a part of their study a thorough 
susceptibility study in order that the weak links of the chain may 
be found and guarded against before the break comes, rather 
than waiting for the irreparable break and using it as the danger 
signal, which is all too late and not sensible medical practice since 
it is neither preventive nor prophylactic. 



MM M.IMIa I IONS & DEGENERATIVE DISEASES CLINICAL VOL. II 

We should discuss in this connection reflex irritations as causa- 
tive factors in producing central nervous system disturbances in 
addition to the disturbances of dental origin of an infective na- 
ture. Such a case is as follows : 

Case No. 1082. A girl of twenty-one has been in a state of 
serious mental break, consisting chiefly of hallucination and aber- 
ration without violent symptoms and maintained as a quite even 
and constant lesion. The history of the case is as follows: There 
is a very marked tendency to insanity on her father's side of the 
family. Several cousins have been affected. About six years ago, 
while motoring in the East, she and her party found themselves 
quarantined because of the epidemic of poliomyelitis. The em- 
barrassment and fright brought on a most violent alarm and fear 
of infection, which is her chief obsession. Every particle of food 
that she ate had to be boiled and boiled to kill all germs, particu- 
larly for fear the germ producing infantile paralysis might be 
present. If any member of her family had been out riding and 
brought his or her gloves into the room where she was, she would 
have a paroxysm of alarm. When brought to my office, she 
brought her own drinking water which was the only water she 
would permit to be used about her mouth as well as her own 
drinking glasses which had been boiled, probably for hours. A 
sealed jar, glasses, etc., were wrapped in towels that had been 
baked in the oven until they were brown from the over-heating. 
Great care had to be taken not to allow the cleaning woman to 
pass through the part of the building where she was. She would 
instantly place one of her burnt towels over her mouth. The 
roentgenograms of her teeth are shown in Figure 422; and, inci- 
dentally, the films for these had to be wrapped individually by 
her in sterile gauze, which she brought for the purpose, before 
they might be placed in her mouth. The infected molar and the 
seriously impacted third molar were removed at separate sittings, 
with so great a change that she invited people to come to see her, 
who had net been permitted to do so for years; whereas, pre- 
viously, she would go out of the house only when it was raining. 
for even her dental appointments had to be postponed until a 
suitable rainy day was found when there would be no germs in the 
air, a difficult condition to fulfill in Cleveland. She shortly im- 
proved so greatly that these problems largely disappeared. It is 
quite impossible to say how much of the disturbance in her case 
was sympathetic, due to the impacted third molar, and how much 



CHAP. LXVI NKRYOl'S SYSTEM AND SENSE ORGANS MENTAL CLOUD 307 




Figure 422. Dental condition of Case No. 1082. Mild insanity greatly improved by removal of dental 
pathological condition. 

to the infective process of the first molar. It is probable, how- 
ever, that the former was an important contributing factor. 

This girl, while very greatly improved, has not returned to 
normal; nor do we believe that, particularly in the sense of her 
susceptibility to break of the central nervous system which in her 
case is an inherited quality, she can ever become normal. In 
other words, her normal carries a deficiency, which deficiency 
may become a first factor in the development of a defect. 

Case No. 1401. — A still more striking case is the following: A 
young married woman, age twenty-two, had been in an asylum 
for two years, with violent spells, which, at one time, required her 
to be in a strait- jacket. Frequently, her hands had to be tied, and 
she practically always had to be under guard. When brought to 
me for study from a neighboring city, she was kept under guard 



Private Records of Weston A. Price. M.S.. D.D.S.. 8926 Euclid Avenue. Cleveland. 


Ohio 






RESISTANCE AM) SUSCEPTIBILITY CHAR 

iv.mm TV w.E. Caue No 1HS u -' 3L 




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* 



Figure 123. Susceptibility record of Case 785. with sciatk rheumatism and heart, 
note marked hereditary susceptibility, with five deaths from heart involvement on 
father s side \\1> one ( vse • >n mother's side. 



3 18 



CHAP. I..W 1 NERVOUSSYSTEM ANDSENSE ORGANS MENTALCLOUD 309 

all of the time. The history indicated that her central nervous 
system disturbance began about three years before, was progres- 
sive in its onset, and there had been no abatement of the severity, 
or but slight. Her parents said to me how much they wished they 
could see her die, as they had been advised there could be no hops 
and her case was getting progressively worse. In about two 
weeks' time after her return to the asylum, her parents were 
notified that she could return home, which she did. This occurred 
in June. The following September she went away to college ap- 
parently perfectly normal, took up music, and the following 
spring stood at the head of her class of sixty, having made a most 
remarkable record and with no tendency to break. This occurred 
six years ago and she has had no break since. In order that I 
might have a late report of her case, I have just written to her 
mother regarding her, and she writes, "M— —is as well in every 
way as a girl can be." A study of the family history reveals that 
her father had suffered from a very serious nervous breakdown, 
her mother a less serious one, and her brother had a mental 
obsession. 

In this connection, it might be inferred that insanity may be 
due, generally, to dental infection. This is so far from being the 
case that we deemed it best to illustrate a case in which there is 
no apparent connection between the dental and the mental lesion. 

Case No. 1139. — The patient, a man age thirty-six, had been in 
an asylum for the insane for several years with recurring attacks 
of a very serious mania in which he would not recognize even his 
nearest relatives. These periods would last for days and would be 
followed by states of apparent normality. The roentgenograms 
of the dental conditions are shown in Figure 421. It will be noted 
that his teeth are all apparently normal except the lower left 
second molar which had recent caries, extensive but not seriously 
involving the pulp. Thermal and electrical tests of his teeth 
indicated them to be normal. We advised that the dental condi- 
tions were not responsible for, nor contributing seriously at 
present to, his mental condition. The only questionable tooth 
did not have a history extending back over the period of mental 
disturbance. This tooth was extracted as a matter of prophyl- 
axis; but, as we expected, there was no improvement in his con- 
dition. If, however, this patient had developed a series of 
one or more serious dental infections, particularly of a locked 
area type, this source or any other source of streptococcal infec- 





■x. 

2 



- - 
_ /. 



- < 



310 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS NEURITIS 311 

tion, and probably several other types of infeetion, would have 
tended to aggravate the mental lesion. 

There is, however, a type of border-line case that is exceedingly 
difficult to interpret. The patients who are at best living in a 
zone of marked tendency to nervous affection will have that con- 
dition aggravated seriously by dental infection. Such a case is 
illustrated in the following: 

Case No. 785. — The patient, age thirty-six, had been in bed for 
six months approximately, with acute neuritis and nervous symp- 
toms. He had suffered very severely. The removal of several 
dental infections, while he was in bed, made an immediate im- 
provement which was practically complete so far as his neuritis 
was concerned. His irritable nervous system, however, was a 
constant menace; and while he has had no return of his neuritis 
for four years, each type of overload, worry, and exhaustion, has 
tended to bring about a nervous break. His heart condition, 
which was alarming during the period of his acute neuritis, has so 
greatly improved that he takes care of a large business effectively. 

A study of his susceptibility chart, shown in Figure 423, illus- 
trates the marked inherited susceptibility. He has strongly in- 
herited nerves and rheumatic susceptibility from his mother and 
heart susceptibility from his father's side of the ancestry. It will 
also be seen, that his father, his father's mother, and three of his 
father's brothers died of heart affection. One of his mother's 
sisters has a heart affection. We must, therefore, come more to 
think of the host and his or her normal defenses as being the most 
important fundamental factor; for a normal high defense may, 
and usually will be, ample to defend people against even large 
amounts of dental infection during the greater part of their life- 
time; but people without that defense are already in grave dan- 
ger; and insurance companies will doubtless come to place great 
stress upon the presence or absence of streptococcal susceptibility, 
and the individuals without the normally high defense will receive 
less consideration than those with an ample streptococcal resist- 
ance in so far as their inherited susceptibilities are concerned. 

A striking illustration of an extreme neuritis in an individual 
with, normally, a high defense is shown in the following case. 
Case No. 449. — This patient, male, age forty-three, had so severe 
a neuritis in his back and hips, which had lasted for twelve weeks 
and had been progressively getting worse, that he could not sit in 
a chair; he had either to stand or lie down. The removal of the 
dental infections, shown in Figure 424, completely relieved his 



312 DENTAL INFECT] >NS& DEGENERATIVE DISEASES CLINICAL VOL. II 

neuritis in about three days; and in five years' time, there has 
been no recurrence. I lis susceptibility chart shows his case to be 
one of strikingly acquired susceptibility, there being no evidence 
of neuritis in either the immediate family or his ancestry. This is 
the type of case in which a prognosis should be considered favor- 
able. 

NERVOI S BREAKDOWN. 

( )f the many nerve lesions, probably none are more pitiable 
than those involving the mind. However, if there is coupled with 
the mental break an acute neuritis, the case becomes much more 
distressing. An illustration of such a case is the following: 

Case No. 805.^ Arrangements had been completed and the day 
set for taking this patient to an insane asylum because of a palsy 
that made her a supposedly hopeless bedridden invalid. The 
palsy of her extremities began about four years ago, with increas- 
ing sever ity, with its onset as a nervous breakdown; and her 
prostration was accompanied by severe pain of obscure neuralgic 
nature. She was carried to our ward. The condition of her teeth 
is shown in Figure 425. There was an early and very marked 
improvement after the removal of her dental infections, which 
expressed itself in the mental lesion, the palsy, and the neuritis. 
Within a few weeks after the removal of the dental infections, 
she was so greatly changed that she returned to the office alone on 
the street car, and walked without difficulty, without even a 
cane. Notwithstanding her age of sixty-seven, instead of being 
an embarrassing burden to her household, she became very help- 
ful, for she not only was able to take care of herself but assisted 
in taking care of others. 

CHOREA 

As previously stated, of the many lesions produced or aggra- 
vated by dental conditions, few are more distressing and baffling 
than are those of the central nervous system, affecting the mind. 
In our mixed clinic we find that, approximately, seven per cent 
of the patients presenting for study of the relation of systemic 
disease to dental infection are recorded to have had mental cloud. 
We have seen so many times an improvement or complete relief 
by the removal of dental infections that we have come to think 
of these functional disturbances as being pretty largely the result 
of structural change due either to bacterial or toxic invasion. In 
children these affections may involve both lack of coordination 
and more or less severe psychic irritation, characterized by the 



CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS CHOREA 313 

patient's irritability and impetuosity, and even violence, all of 
which so often make up the picture of chorea. A typical illustra- 
tion is as follows: 

Case No. 458. The patient, nine years of age, was brought by 
his mother with the following history. As the tears streamed 
down her cheeks, she said, "Why have my husband and I been 
cursed with such a wicked boy? The teacher sent him home with 
a note saying that if he returns she will leave the school. He can- 
not play with children without slapping them in the face or some 
other unpardonable violence without provocation. He does this 
also to his father and to me. While keeping him out of school, 
since we have to, I thought it would be a good time to have his 
teeth taken care of, etc., etc." We made a few studies of the boy 
and soon found that he had largely lost his power of coordination. 
He had a very sharply developed symptom group chorea with an 
exaggeration of the irritability phase. While undertaking to 
make roentgenograms of his teeth, he would strike me in the face 
without any provocation. In addition to making these studies, 
w r e made motion pictures of his lack of coordination. It was 
apparently impossible for him to sit still, and every moment he 
was twitching and jerking and, as such patients do, would try to 
turn an involuntary muscular contraction into a voluntary one. 
He would find his knee jerking up, and, in order to avoid the em- 
barrassment, would turn it into a kick; and similarly with his 
hands. If he had something in his hand at the time the involun- 
tary reflex occurred, and his hand started swinging, he would let 
the article fly as though he had intended that to be the movement. 
We do not wonder that his teacher had reached the limit of her 
capacity to control, for no ordinary power could control him, not 
even his own mind. We explained to the mother that her boy 
was not a bad boy ; that he had an infection of the cortex of the 
brain, probably largely coming from his infected teeth; and that 
when his infection was removed he probably would return to 
normal. With very great difficulty, because of his extreme condi- 
tion, we succeeded in removing the deciduous teeth which were 
deeply carious, several of which had infected pulps. These were 
cultured and animals were inoculated, several of which developed 
very acute involvements of the central nervous system; and we 
had four at one time of this series with such marked central nerv- 
ous system disturbance that with little excitement they would 
fall on their sides. Sections made from the cortex of the brain 
showed multiple petechial hemorrhages and diplococcal zones of 



Mil DENTALINFEC riONSA DEGENERATIVE DISEASES CLINICAL VOL.11 

infection. Immediately after the removal of these teeth the 
boy's condition improved and very rapidly he returned to normal. 
In two weeks' time he was back in school, a normal child, and has 
not had a single recurrence in five years. 

1 have young patients whose histories are so definitely sugges- 
tive of this type of affection, since they have previously had in- 
volvements of chorea or acute nervous affection with irritability, 
that 1 have warned their parents to be sure to let me know if at 
any time these symptoms became apparent and to bring the 
child in. Such a case is as follows: 

Case Xo. 1 102. The father had been a partial invalid from a 
heart involvement and rheumatism. His father had died at about 
fifty years of age from heart involvement. This lesion had been 
dominant in the father's side. The mother had the history of 
nervousness which had been dominant on one side of her ancestry. 
The oldest child had died under a simple operation from strep- 
tococcal septicemia, the susceptibility to involvement from which 
organism is definite in both sides of the ancestry and which in 
great probability accounted for her being such a poor risk. This 
child had, at different times, had marked nervousness. With the 
attack in question, the mother called me on the phone and said 
that her little girl had developed just such symptoms as I had 
advised her to watch carefully for; that she had been sent from 
school, would slap her parents in the face and drop things, so 
characteristic of choreal patients. On account of the marked 
familial susceptibility to streptococcal infections, I desired that 
she should not, under any circumstances, have an infected pulp- 
less tooth. This patient was exceedingly hard to operate on and 
the tendency to caries was very great. In spite of our effort and 
care, largely due to the lack of cooperation, she had developed an 
infection of the pulp of a deciduous tcoth from a proximal caries. 
On being given this information over the phone. I arranged to 
have the child brought to the office immediately; and on finding 
the difficulty, arranged for a very early operation for the removal 
of the infected deciduous tooth shown in Figure 126. This was 
done on Saturday morning, and on Monday the mother tele- 
phoned me that her daughter was so much improved that her 
nervous twitching had stopped, her irritability was practically 
gone, and she thought she could go back to school. Kindly note 
the lack of roentgenographic evidence of a putrescent pulp in the 
first deciduous molar. 

When we think of the tragedy of ignorance during all the past 



CHAP. LXV1 NERVOUS SYSTEM \ND SENSE ORGANS EXHAUSTION 315 



Figure ii'ii. Infected deciduous molars, 

WITHOUT ROENTGENOGH M'lIK K\ IDENCE OF SAME, 
WHICH WERE PRODUCING CHOREA IN ^ CHILD. 

Case No. 1402. 




v 



centuries, and so little improved in our own generation, our hearts 
go out to the child life which has been misunderstood amidst all 
its suffering. History records that a few centuries ago it was a 
practice to drive these children with switches to the tomb of St. 
Vitus with a hope of the removal, thereby, of their affliction; and 
this seems to have been the origin of the name St. Vitus's Dance. 
How many children today are suffering from such infections we 
can only guess, but from the number I see, I am convinced that 
the affliction is a very common one; and its pathology strongly 
argues in favor of the removal of all infected deciduous teeth and, 
primarily, for a program of prevention through nutrition and 
prophylaxis that will make the development of the caries, which 
shall infect those teeth, impossible. This will only be brought 
about by an intelligent dental profession, guiding wisely, and 
creating a well informed public, which latter has shown evidence 
of being just as anxious to learn as has the dental profession. 

NERVOUS EXHAUSTION. 

Few, if any, of the lesions of the body which may come under 
consideration as being influenced by focal infection, and particu- 
larly dental infection, are so obscure as the so-called functional 
diseases of the nervous system. We have thought of functional 
diseases as being something entirely different from those due to 
structural changes. It is a question, if there be such a thing as a 
functional disease without structural change; indeed, there 
probably cannot be. 

The patient whom we shall use as an illustration of this type 
of lesion suffered from a group of symptoms, some or all of which 
are exceedingly common; and her case had been diagnosed by her 
physician as one of hysteria. At times she had severe pain in 
various parts of her body, for which no adequate cause could be 
found. She frequently had an extreme sense of fatigue and weari- 
ness, for which also no cause was found. At times she had symp- 
toms of a heart involvement, and with it all, a sense of mental 



316 DEN I \l. I Ml a l [ONSS DEGENERATIVE DISEASES i LINK AI. VOL. II 




Figure 127. Roentgenographic appearance of teeth of Cam: No. 335, with hysteria and lassi- 
tude. See next figure. 

cloud and depression against which she had to struggle. For 
about five years she was compelled to be out of employment, 
approximately half the time because of inability to work. At 
times she could hardly compel her mind to do simple problems. 
One physician, thinking he had found the trouble, had an ovary 
removed. At another operation, the appendix was removed; and 
at another, the tonsils; none of which produced any marked 
change in her condition. 

Her dental conditions are shown in Figure 427. A striking and 
typical illustration of the type of dental pathology that developed 
in her case is seen in the lateral, the pulp of which is non-vital. 
There was no history of soreness, exceedingly limited zone of 
apical absorption of alveolar tissue, and no fistula, and never had 
been; the very type of local condition which we now interpret as 
indicating an inadequate reaction on the part of her system 
adequately to protect her against her own infection an ineffi- 
cient local quarantine. 

In order to understand this case, it is necessary to go back and 
analyze the measure and quality of her defense or susceptibility. 
the nature of her overloads, and the type of inheritance that 
would establish her defensive mechanism. This is shown in 



CHAP. LXV1 NERVOUS SYSTKM AND SKNSK ( >K(-ANS KXIIAISTION 317 

Figure 428. The patient's age at that time, seven years ago, 
was thirty-four. Her net weight was about 103 pound". Her 
chief disturbanees have been rheumatism, a type of nervous 
breakdown, and heart involvement, with operations for appendix, 
ovary, and tonsils; and she has been breaking seriously, young in 
life. A study of her brothers and sisters shows that her only 
brother died of a heart infection at six years of age ; and that he 
had acute rheumatism and chorea. She has five sisters, two of 
whom have had acute rheumatism, five nervous involvements, 
and two acute heart involvements. Her father died of acute 
heart involvement at sixty-five. He had very marked sensitiza- 
tion as asthma. Two of the father's sisters had had very severe 
nervous disturbances and died of heart involvement, and all 
three had heart involvements. Rheumatism and heart were very 
dominant in the father's side of the ancestry. The mother and 
her brothers and sisters had been mildly susceptible to rheu- 
matism, and two of her sisters and a brother had had heart in- 
volvement. The mother's mother had a heart involvement. A 
great grandparent on the mother's side had been chair-ridden 
from deforming arthritis. There had been nine cases of heart in- 
volvement among the immediate relatives and ancestry, four of 
whom had died ; and if the second cousins were included, the num- 
ber would be increased to sixteen. Her father was a sufferer from 
asthma, which frequently made him very greatly distressed; and 
as we now understand that disease to be a sensitization process 
and know personally of the symptoms, believe it was sensitiza- 
tion and an allergic reaction to a certain weed, that grew abun- 
dantly in a certain field of his place. We would, therefore, inter- 
pret her case as being one of inherited low defense to streptococcal 
infection; and probably definite susceptibility by inheritance 
from her father to sensitization reactions. The type of dental 
pathology also, as outlined, indicates low defense. 

As this case has been in my care during the last fifteen years, 
I have had an opportunity not only to observe the various and 
changing symptoms, but to study them critically, in connection 
with our increasing knowledge of the nature of dental infections and 
their reactions. From the standpoint of the development of the 
history, it is important to know that we adopted a very conserva- 
tive program. One or two at a time, only, of the teeth were ex- 
tracted, which had had root fillings placed within them and which 
we interpreted as having insufficient pathology to account for 
her disturbance. After each extraction, there would be marked 



318'DENTAL INFE< HONS & DEGENERATIVE DISEASES CLINK M. VOL.11 



Private Records of Weston A. Price, M.S.. O.D.S.. 8926 Euclid Avenue. Cleveland. 


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FlGURl ,28 SUSCEPTIBILITi RECORD "I CASE NO SUFFERED UITI- LASSITUDE 

HYSTER1 \. Ml \Kl. \\n Rill l MATISM. NOTE 11 \ ( \-l SOF HE \K'T INVOI VEM1 Nl IN i' Will V. 



CHAP. I. \\l NERVOUS SYSTEM AND SENSE ORGANS EXHAUSTION 319 

improvement which, however, would be temporary. Autogenous 
vaccines were made from the cultures of these teeth, and these 
gave definite but temporary relief. From time to time, during a 
number of years, the clinical picture would improve after the ex- 
tractions and use of the vaccines. The subnormal temperature, 
ranging about 96 in the morning to 97 in the afternoon, would 
come up, under the influence of the vaccine, a degree or a degree 
and one-half, and, accordingly, be normal in the afternoon. This 
patient, like all of her class, was always sensitive to cold ; and this 
symptom would always improve. At times, she developed bursi- 
tis; on another occasion, herpes; but the chief lesions were obscure 
but definite pains with or without a sense of weakness in her 
limbs; and above all, the sense of lassitude. With the removal of 
her last root-filled tooth, these symptoms improved as they had 
with the extraction of other teeth, with the exception that the 
improvement was much more marked; and in five years' time 
there has not been a single recurrence of any of the symptoms, 
sufficient to make her lose a day of time from her work. She has 
gained in weight. Her general physical and nervous condition 
has come to, and remained upon, an entirely different level from 
where they had been for fifteen years previously. She was 
in the position of being criticized by her physicians and most of 
these with whom she came in contact as having affections which 
were largely imaginary, or that she was enjoying her discomforts. 

We believe she is typical of a class containing a large number of 
individuals whose condition is partly one of sensitization, which 
sensitization is an allergic reaction to a protein, being generated 
within the individual's body as a result of bacterial infection, 
and which antigen may be present in sufficient quantities to pro- 
duce such reactions, in even a root-filled tooth without periapical 
evidence, as revealed by the roentgenogram; that a normal indi- 
vidual will destroy this antigen or neutralize it by an antibody- 
antigen reaction close to the tooth; whereas, this patient, not pro- 
ducing such a reaction, permits that antigen to invade the system 
and irritate the tissue that has become sensitized to it. In the 
chapter on Sensitizations we have discussed the nature of these 
reactions and methods for diagnosing them. W T e believe these 
cases are also continually subjected to bacterial infection of this 
type from these root-filled teeth, for all of the teeth extracted 
from this patient were found to be infected. 

Another important phase of the expression of this case is of 
particular interest because of its possible relation to a type of 




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CHAP. I..W I NERVOUS SYSTEM AND SENSE ORC.ANS MEMORY 321 

mental disturbance, the etiology of which has been very obscure, 
and which relates to an affection of speech which is limited to 
certain words. One of the words in this case was total, and it not 
only required distinct mental effort to write it, but produced a 
distinct sense of pain. Another expression was the inability to 
remember certain names and words that were very simple. 

This memory disturbance may take on a very extreme or 
alarming expression, an illustration of which is the following case: 
Case No. 1367. — This patient presented with a history of attacks 
of less of memory with increasing severity, extending over a 
period of four years. The last attack had lasted five days and he 
was so nearly void of mentality that he would eat when things 
were put before him but lacked judgment regarding eating. His 
attacks would come on with at first a sense of excitement, then 
extreme nervousness, followed by a period of crying. During the 
onset of his last attack he drove his automobile thirty-five miles 
in forty-eight minutes on dirt country roads and could not recall 
the trip or any incident in connection with it. His history showed 
that several years ago he had several teeth covered with gold 
crowns, as shown in the roentgenograms, Figure 429, some time 
after which he began developing these serious symptoms. His 
first attack was brought on while moving a troop of soldiers to 
encampment during the war, at which time, as the commanding 
officer, he was without sleep almost continuously for four days. 
The first symptom was a slight and transient disturbance of 
memory. He has seen impending the probabilities of a madhouse 
where he would be a helpless idiot, since each attack, coming in 
regular succession, was progressively worse than the preceding. 
His present joy can be imagined from the fact, that since the 
removal of the gold crowns and the infected teeth he has not had 
one single attack. A study of his susceptibility and that of the 
family reveals his exceptionally high inherited defense on both 
the father's and mother's sides. 

The patient's own description of the change is significant. 
When first examined a month after the removal of his infections 
he was looking very much better, had gained six pounds, stated 
that he had been entirely free from his feeling of mental cloud and 
tendency to lapse of memory. He described the former condition 
as being one in which he had been going up an incline for four 
years, during which time he never once returned to normal as he 
has since the removal of the dental infections, as though he had 



:V2'2 DENTALINFK I I0NS4 DEGENERATIVE DISEASES CLINICAL VOL.11 

returned from that elevated plateau of strain, pressure, and 
mental cloud, back to a lower plane. During that period he was 
under a sense of pain and cloud, which conditions have entirely 
disappeared and he has a feeling of buoyancy. He looks quite 
different in the face and has a mental alertness that is apparently 
normal. He expresses his former condition as one in which he- 
would have to stop to think to answer simple questions, as, for 
example, "How much do two and two make?" When crossing 
the street, he would have to stop and study what crossings were 
and where they were. When these attacks first started, his brain 
seemed to act as a slow moving picture. At the time he presented 
he had been suffering from that attack for eight weeks, which was 
the longest that any of them had lasted. The longest previous 
had been four weeks. At the time of his first presentation his 
facial expression was that of frenzied delirium. His eyes were 
bloodshot and staring, his face drawn as though he had been 
through a horrible and harrowing experience. Within a few days 
after the removal of his dental infections, these symptoms 
rapidly disappeared. His case had had the most painstaking and 
skillful care and study by internists during these four years, the 
physician who sent him from another city being convinced that 
all other sources of possible cause had been excluded. 

In interpreting his case we must keep in mind that capacity for 
endurance is a relative matter and always relates to overloads. 
It is probable that his first but mild break was dependent upon 
both his locked dental infection i for pulps were found non-vital 
in some of the crowned teeth) and his extreme strain and oxer- 
load, carrying out his war duties without proper rest and nourish- 
ment. Had it been due entirely to the latter he doubtless would 
not have had recurrences when he came to a normal program of 
life again. But he quite soon came to a point where even with the 
most exacting care these conditions developed. His is a case of 
acquired susceptibility in an individual who normally shouici 
have a very unusually high defense both by personal physique and 
inheritance, and demonstrates that it is not sufficient to build 
our trestles with a strength sufficient for the ordinary load, but 
always provide for a factor of safety, for every individual will 
have some overload and many will have excessive overloads at 
times in spite of all good planning that they or we may do for 
them. The responsibility of dentistry is very clearly to refrain 
from building not only additional sources ol overload, but sources 
of toxin and infection which are the neglected camp fires that 



CHAP. I.XVI NERVOUS SYSTEM AND SENSE ORGANS ENCEPHALITIS 323 

start the conflagrations which devastate the forests. But, as the 
brush would not take fire without ignition, so these serious breaks 
in the nervous system frequently cannot come without a source of 
toxin. 

EPIDEMIC LETHARGIC ENCEPHALITIS. 

In discussing this very severe group of disturbances of the 
central nervous system, we are dea.ing with one of the most dis- 
tressing of human afflictions, for many of the individuals are 
doomed to a life of broken mentality or dismantled nervous 
system, or both of these conditions, to eke out an existence that 
is almost unbelievably painful and pathetic both for themselves 
and for those with whom they are in contact. I shall not under- 
take, for lack of space, to review its symptomatology except to 
review that any structures of the central nervous system may be 
attacked, and, when attacked, the probabilities of a permanent 
lesion are very high. If they do not die within four weeks, the 
prospects are that they will live on perhaps indefinitely. They 
may have any degree of paralysis from a single group of muscles 
to practically the entire body. A brief statement is as follows: 
"A disease of obscure pathology and showing unusual cerebral 
symptoms, the distinctive features being an increasing languor, 
apathy, and drowsiness, passing into lethargy. There is progres- 
sive muscular weakness and various cranial nerve palsies." 
(Dorland) In the current press it is spoken of as "Sleeping Sick- 
ness" because that mental apathy and drowsiness are often inter- 
preted as sleep. There is no generally accepted etiology though a 
diplococcus has frequently been isolated from these cases. In 
the case that I shall review I do not know that we have been deal- 
ing with the causative organism though several factors have been 
very suggestive that we have. 

The woman, age thirty-six, was brought to us with spasms of 
the face, with the grating of her teeth, twitching of the left arm, 
and drawing up of the legs, and was so horrible to look at that 
some of the members of my staff found it necessary to leave the 
room. The involuntary grating of her teeth could be heard 
through the surrounding rooms from where she was sitting; and, 
needless tosay,shehad loosened several of them from the uncontrol- 
lable and violent spasms of the muscles of mastication. At times 
the attacks would come on so violently and suddenly that the 
snapping of her teeth would endanger a serious wound to anyone 
having a finger between them. This trouble came on following 
an attack of Flu three months previously, which is the history of 










324 



CHAP.LXV1 NERVOUS SYSTEM VND SENSE ORGANS ENCEPHALITIS 325 

many of these eases. The diagnosis was verified by a neural 
pathologist and the prognosis was, of eourse, considered very 
grave, and our efforts were devoted to studying the relation of 
dental infections, if any, to her condition and to the making of 
supports that would sustain the violent spasms without the com- 
plete destruction of all of her teeth. The neurologist took charge 
of her medical care. 

Her dental conditions, as she presented, are shown in Figure 
430. When these infected teeth were studied by our various 
means, including planting beneath the skins of rabbits, it was 
found that they contained an organism which at that time we 
thought to be very exceptionally virulent. We have, however, 
since found several instances where teeth were quite as rapidly 
fatal from patients who had no such symptoms. One of the teeth 
from this case at the time of this writing has been planted beneath 
the skins of over thirty rabbits, all but two of which died spDn- 
taneously within a few days, averaging about four days, the 
longest being ten days. Two were chloroformed just before 
death for study. Several other teeth from this patient were 
studied in the same way and all produced comparable results. 

In the course of our studies the planted teeth were placed in the 
subcutaneous subdermal tissues, chiefly of the back. Another 
method of study was to place a very small quantity of these 
germs, under aseptic conditions, subdurally through a very finely 
drilled hole of the frontal brain. As controls, cultures were used 
from other sources. In one instance the rabbit produced violent 
spasmodic grating of the teeth in about two hours, which lasted 
for about five hours and ended in death, very strikingly similar 
to those suffered by the patient. We are not justified in conclud- 
ing that this is specific for elective localization or reproduction of 
identical symptoms, since infective meningeal involvements 
sometimes produce these symptoms and we were able to produce 
similar though not identical reactions with other strains, not, 
however, so characteristic and violent. In two rabbits, one of 
which was inoculated with the aspirated material from about the 
tooth that had just killed a rabbit, and the other with this same 
material passed through a Berkefeld filter, the former died in a 
few hours with characteristic spasms, the latter lived for weeks, 
indicating that there was not free toxic substance within the 
bacterial growth. Intravenous inoculation of this strain did not 
produce typical lethargic encephalitis in rabbits. This, however, 






326 DENTALINFEC fIONS& DEGENERATIVE DISEASES CLINICAL VOL.11 




2 



CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS EYE 327 

may not have significance since the history of inoculations with 

this strain isolated from patients suffering from this disease have 
been found by other workers not to produce the typical lesions of 
the nervous system unless inoculated subdurally. Several things 
are important for consideration, and these we may put in the form 
of questions. 

( 1 ) .Since the etiology is so obscure, and since a diplococcus has 
been found by many of the investigators, is it possible that the 
growth in the individual's body of the organism or organisms 
producing the symptom group of influenza may create a condition 
which induces the streptococci or diplococci growing in dental 
infections to develop this type of tissue affinity? 

(2) Is it possible that a specific strain of diplococcus or strep- 
tococcus becomes a contaminating factor in dental infections 
and, by residing in that nidus, maintains a perpetual infection of 
that individual's body through the dental channels? 

(3) May it be possible that a specific organism gains its en- 
trance into the body through carious teeth? 

These are all problems of the most pressing character and de- 
mand the best attention of the profession which can only be given 
by an adequate program of research which is not being recognized 
today, and which can only be undertaken with hope of the largest 
possible success in a specially organized institution where that 
problem along with others of the dental group can receive the 
merited study. 

EYE. 

No part of this work has been more striking and satisfactory 
than the relief in cases of eye involvement, of which there have 
been many types. A very striking and common type has been 
affections of the various coats of the eyeball. These can probably 
be best discussed as individual cases. 

Case No. 904. — The patient, male, forty-five years of age, good 
health, presents with an acute inflammation involving, with other 
structures, the retina and sclera of the right eye. The dental con- 
ditions w y ould not be considered serious if judged by the roent- 
genograms, shown in Figure 431. Two of these teeth were ex- 
tracted : namely, the right maxillary first molar and first bicuspid. 
Cultures were made and the culture inoculated into five rab- 
bits. Four of the five developed acute affection in various struc- 
tures of the eyeballs. This patient's inflammation was so acute 
that he was compelled to be in a darkened room for weeks, and 
the vision, which had been reduced to about one-fifth normal, was 







M 
FIGURE 133. PROGRESSIV1 INVOLVEMENl IN RABBIT'S EYE, FROM DENTA] CULTUF.E FROM CASE 904 WITH RETINITIS. 






CIIAP.LXY! NKRVOl'S SYSTEM AND SENSE ORGANS KYK 329 





®. 9 



Figure 434. Of five rabbits inoculated with culture from teeth 
of Case 904, four developed acute eye involvement. Two shown below 
have ulcers, and two above acute infection of musculature. 

considered in great jeopardy. One of the rabbits inoculated with 
this culture developed lesions which were strikingly severe. 
This is shown in Figure 433. A shows the typical appearance of an 
eye in this condition. Reading from left to right, will be s en 
different stages of the rabbit's right eye. First, a violent general 
retinitis and choroiditis, shown in C; in D, taken a few days later, 
the vision had entirely disappeared; in E, a deep ulcer is develop- 
ing; in F, the extent and depth of the ulcer is revealed, also a very 
marked conjunctivitis; in G, repair has set in but the vision is 
gone ; H and I show later stages of the healed scar but no return 
of the vision. B shows the rabbit's left eye which remained nor- 
mal during the entire period. This rabbit was kept for nine 
months and posted and the eye retained as a specimen. Other 
eyes from rabbits of this series are shown in Figure 434, revealing 
very marked involvement of the sclera and musculature. 

The most striking thing about this case is the history. This 
man's father is living and is partially blind in one eye. His 
father's mother lost the sight of both eyes and died blind, and her 
mother also died blind. In eleven hundred rabbits inoculated, 



330 i 



,l,M M. INFEC 1 1' >NS& I CGENER A 1 1\ EDISEASES C LINK AL VOL II 





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CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS EYE 331 

not three per cent have developed eye involvements; whereas, 
in five rabbits inoculated for this patient, four, or 80 per cent, 
developed eye involvement. We are advised by this patient 
that his vision has returned practically to normal and there has 
been no recurrence of his trouble. 

It now seems probable that many of the cases of gradual or 
sudden blindness have had their origin in infected teeth. As an 
illustration we will present the following case. Case No. 1087.— 
The patient, male, age fifty-six, presents with a history of glau- 
coma of the right eye, completely blind, and the vision of the left 
eye reduced to one-fifth, and progressively getting worse. The 
patient was not able to go on the street alone. His apprehensive- 
ness of the approaching total blindness had made him almost a 
nervous wreck. His dental conditions are shown in Figure 432. 
A striking characteristic of the dental condition in his case was 
the very marked excementosis of some of the roots, particularly 
of the upper right molar. The ball on the apex of the mesiobuccal 
root created a condition that made it possible to rotate the root 
round and round, but it could not be removed until the buccal 
plate was removed. A section of this tooth is shown in Figure 435. 
The extensive lamination is very strikingly illustrated. Cultures 
taken from this and other teeth of this patient, when inoculated 
into rabbits, produced eye involvements in 100 per cent of cases. 
The most important part of this case and its history is the follow- 
ing: Whereas, his left eye was progressively losing its vision, it 
not only has ceased getting worse but it actually improved suffi- 
ciently, so that within a few weeks after the removal of his dental 
infections he was able to go on the street alone, and the condition 
has been progressively, but moderately, improving for over a 
year and one-half. This is an illustration of a case of an acquired 
susceptibility. The patient's defense should normally be high. 
Both sides of his ancestry were exceedingly clear of rheumatic 
group lesions. 

I have no doubt that many types of blindness do not have their 
origin in dental infections, one of which is very serious. It is the 
blindness of ignorant dentists who have so little knowledge of 
focal infections that they are creating, with a confidence that is 
based only upon their ignorance, a great many dental conditions 
which some day may make blind patients. These dentists them- 
selves may never know, and the patients may never know that the 
delayed development of knowledge in the dental profession is fun- 
damentally the cause. Nevertheless, I believe confidently that 



DENTALINFEX flONS & DEGENERATIVE DISEASES CLINICAL VOL. II 




FIgure 436. Acute conjunctivitis in rabbit, produced by culture fr >\i infected tooth in I), from Case 

NO. 899 WITH CHRONIC EYE IRRITATION AND HU> INVOLVEMENT. 



mistaken judgments in this particular are responsible for a very 
large number, if not a large per cent, of certain types of optic 
lesions. The price that humanity pays for progress is appalling. 
It has always had to come that way. 

Another type of eye involvement, and which is quite common, 
expresses itself chiefly in irritation and conjunctivitis. It usually 
involves both eyes and is illustrated by Case No. 899, a man, age 
fifty-three, who had severe arthritis which had been diagnosed as 
an osteomyelitis of the left hip, with a marked shortening of the 
right leg. This chronic eye irritation had made it impossible for 
him to use his eyes for reading for considerable time; and the 
combination of eye involvement and arthritis was aggravated by 
a marked sense of mental cloud or discouragement against which 
he had to fight continually. He had been incapacitated for work 
for about two years. A culture taken from the root-filled tooth 
shown in Figure 436-D, when inoculated into a rabbit, produced a 
very acute conjunctivitis with lacrimal discharge, very similar to 



CHAP.LXVI NERVOUS SYSTEM AND SENSE ORGANS EYE W.YA 

that suffered by the patient. The rabbit's normal eye is shown in 
A, and two stages of the eonjunctivitis in B and C. With the 
removal of his dental infeetions and the use of a vaccine, this 
patient's eye trouble entirely cieared up and his rheumatism im- 
proved so much that instead of being practically helpless, he was 
able to return to professional practice; and a few months later, he 
invited me to take a walk with him, when he covered about five 
miles with no apparently bad effects. There has been no return of 
the eye trouble. 

There is no doubt that several factors combine in a case of this 
kind. The removal of the patient's infection will in itself be im- 
portant in proportion as its quantity and quality are developing 
definite reactions in this patient. If these reactions are in the 
nature of allergic sensitizations, the quantity, as shown in the 
chapter on sensitizations, may be exceedingly small and still pro- 
duce very distressing symptoms. The use of the vaccine un- 
doubtedly assisted him in building up a defense. The fact that 
he has not had a recurrence of his trouble strongly indicates that 
it was not a temporary benefit. 

While we have had a considerable number of cases of eye in- 
volvement, I believe it will be most helpful to use as typical illus- 
trations those in which animal inoculations have been made with 
the cultures grown from dental origin. In Chapter 22 on Elec- 
tive Localization, we have shown that the percentage of animals 
developing eye lesions, where cultures were taken from teeth of 
patients without eye involvements, has been exceedingly low, 2 
and 4 5ths per cent; whereas the animals inoculated with 
cultures of teeth from patients suffering from acute eye involve- 
ments, at the time, have in many instances shown 75 to 100 per 
cent of involvements; in the first case, 80 per cent, and in the 
second case, 100 per cent, notwithstanding the fact that different 
methods of inoculation or of bacterial growth were used as varia- 
tions in the experiment. It is very striking that in patients with 
involvement of one eye, our rabbits have been involved only in 
one eye; and where the patient's involvement was in both eyes, 
the rabbits have in a larger percentage tended to have involve- 
ment in both eyes. The next case illustrates such a condition, one 
eye only being involved. 

Case No. 861. — The patient, an unmarried woman forty-six 
years of age, was referred to me by an oculist with the statement 
that she was rapidly losing the vision of the left eye ; that this was 



334 DENTALINFEC flONS & DEGENERATIVE DISEASES CLINICAL \<)L.II 







Figure YA7. Extreme eye involvement of Casi No. 861. B, C, and D, dental conditions. EandF.pro- 

GRESSIVE STAGES OF \U II- INVOLVEMENT IN RABBIT'S EYE, INOCU1 tt"ED WITH CULTURE FROM THESE TEETH. 



CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS EYE 335 

the fifth successive attack, each one more severe than the pre- 
ceding; and that this was not responding to treatment; that if we 
could do anything, to do it quickly. The roentgenograms of her 
t eeth are shown in Figure 437, and show a zone of rarefaction about 
the bicuspid carrying one end of a bridge, with no evidence of root 
filling, suggesting the irritation of an entire putrescent pulp. The 
other foundation of the same bridge shows but slight rarefaction. 
Electrical and thermal tests revealed the fact that one of her 
lower centrals was non-vital, shown with the small metal filling 
in the roentgenogram. Note that this root apex shows a con- 
densing osteitis rather than a rarefying. 

Cultures were made from the contents of these teeth and all 
were shown to be infected in their pulp chambers. The organ- 
isms from one of them were injected into the rabbit shown in 
Figure 437 with the result shown. A gives the appearance of 
the patient's eye; F, the appearance of the rabbit's eye in forty- 
eight hours; and E, the appearance in seventy-two hours. 
Only one of the rabbit's eyes was involved. Within twenty- 
four hours after the extractions, the congestion and acute 
inflammation had markedly reduced in the patient's eye, and 
was nearly gone in three days. Her vision began to improve 
promptly and returned practically to normal ; and she has had no 
recurrence of the trouble in three years, although she had 
previously had five successive attacks with progressive severity 
in two years. 

EXOPHTHALMOS AND RETINAL HEMORRHAGE. 

A large variety of dental lesions shows evidence of direct rela- 
tionship with dental infections. The patient we will present as 
illustrating this is a married woman, age thirty-nine, Case No. 
1008. She was referred by her physician because of a recurring 
and extremely painful lesion in her eyes, which would sometimes 
come on suddenly in the night with pain so severe that it would 
be necessary to summon her physician who would administer a 
hypodermic of morhpine. There was a very marked exoph- 
thalmos, as shown in Figure 438-A. 

The roentgenograms of her teeth are shown in Figure 439, and 
it will be noted that she had evidence of extensive gingival infec- 
tion, the history of which was an acute involvement that re- 
sponded to treatment a few years previously, since which the 
teeth had been very comfortable. Bacterial examination of the 
gingival pockets showed evidence of a chronic low-grade inflam- 
matory process. Knowing from experience that many of the 









336 1H.VI VL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. 11 




\ 




# « 




Figure 438. Marked bulging of the eyes, Case No. 1003, as seen in a. Eyes 
returned to normal in a few weeks' time, as shown in b. 



teeth with former acute periodontoclasia! involvement have 
degenerating or degenerated pulps, we condemned several and 







337 






338 DEN1 IL INFECTIONS* DEGENERATIVE DIS CLINICAL VOL.11 

made studies of the infection in the pulps and of their structural 
changes. One of these is shown in Figure 1 10. which reveals the 
pulp chamber filled with a multitude of islands of calcification 
which was part of a slow degenerative process. 







: 




m 






Figure WO. Very marked pulp degeneration, with multiple -pulp 

STONES OF PYORRHETM fEETH OF PREVIOUS FIGURE, CASE X". II 



Cultures taken from these teeth and inoculated into rabbits 
produced some very striking results. Of three rabbits shown in 



CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS EYE 339 



1 





Figure 441. Three rabbits which developed acute exophthalmos following 
inoculations with dental cultures from preceding case. no. 1008. 



Figure 441, all had pronounced exophthalmos within eight 
days. Later, four rabbits were inoculated with cultures from 
other teeth of this patient, of which two showed exophthalmos. 
Immediately, the patient's acute eye involvements nearly ceased, 
with attacks so mild and infrequent that they were simply sug- 
gestions and soon ceased entirely. In a few weeks' time, her 






:n<) DEN I \l. IM 1a l [ONS& DEGENERATIVE DISEASES c LINICAL VOL. II 







Figure i 12. A ruptured blood vessel in patient's eye, shown in a. with hemorrhage into sclera. B. \ 

HEMORRHAGE INTO THE EYEBALL OF A RABBIT FROM CULTURE OF TOOTH. C, HEMORRHAGE INTO PERIOSTEUM AND 
MUSCLES. 



eyes reduced in size and protrusion, completely changing her ap- 
pearance, as shown in Figure 438- B. Her eyes returned nearly to 
normal in about six weeks. The effects of the cultures from her 
teeth on other structures of the rabbits were very marked. Figure 
442-C shews a dissection of a rabbit illustrating excessive hemor- 
rhages into the tissue. The periosteum and muscles were par- 
t icularly involved, as shown. Figure 442-B shows a rabbit with a 
hemorrhage in its eyeball and greatly engorged blood vessels. 
In the beginning of the report of this case, we have referred to a 
type of excruciating pain which would come on suddenly, and 
usually in the night, awakening her from her sleep and requiring 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS EYE 34] 

a hypodermic injection of morphine for its control. These would 
be followed by a hemorrhagic infiltration into the choroid, and 
were probably related to a ruptured blood vessel. The cultures 
from one of her teeth, when inoculated into rabbits, frequently 
produced hemorrhages in several of the tissues of the eyes, one of 
which is shown in Figure 442-B. This rabbit also had hemorrhages 
in various structures of the body, including the periosteum of 
both hind legs and the muscles of the thigh. One of these hemor- 
rhages is shown in the patient's eye in Figure 442-A. In Chapter 65, 
I discussed this case from a standpoint of the alimentary tract. 
In a year and one-half there has been almost no recurrence; and 
we have had a struggle to prevail with this patient not to have 
all of her teeth removed. It would be as easy to persuade her that 
it was imagination, that she sees the sun shining, as to persuade 
her that her teeth were not the cause of her involvement. 

In Chapter 60, on the Circulatory System, in discussing bac- 
teremias, I have referred to the fact that patients with a very low 
defense for streptococcal infection may develop a recurring strep- 
tococcal bacteremia, during the attacks of which, the organism is 
found in the blood stream, by culturing. One of the cases cited 
illustrated the large variety of symptoms which may develop in 
such a case. In this connection I wish to refer more specifically to 
the eyes of this patient . Her vision was gradually diminishing. At 
the time she presented, she found difficulty in crossing the street 
unaided. There was a definite cycle to the development of her 
symptoms. Her eyes would become bloodshot, as she expressed 
it, in which condition they were very sensitive to light; and fol- 
lowing this, she would nearly always have attacks of acute rheu- 
matism. In the eye lesions previously reviewed, we have noted that 
only one eye was affected. In her case, practically always both 
eyes would be affected though one might be worse than the other. 
The photograph of her eyes, shown in Figure 443-C, illustrates her 
typical expression, with the eyelids very nearly clcssd to shut out 
the light, and the part of the eye that was visible, almost blood- 
red. Cultures grown from the teeth shown in Figure 443-D and 
inoculated into the rabbit shown in Figure 443 produced very 
definite involvement of both eyes. A shows the eye before the 
rabbit was inoculated, and B the following day. This condition 
cleared up in the rabbit in a few days' time, when it was inocu- 
lated again with the same strain, and again developed an eye 



342 Di.M \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 













Figure 443. An acute involvement of both eyes of patient shown in C. A. normal eve of kabbit. 

B, SAME EYE THE DAY FOLLOWING INOCULATION WITH CULTURE FROM TEETH SHOWN IN D. CASE NO. 



involvement. The eye finally returned to normal. Cultures 
taken from this patient's tooth, from the blood stream, and from 
the eyes, were biologically the same strain of streptococcus. This 
strain was recovered from the patient's blood by culture three 
times. By the use of an autogenous vaccine, which probably did 
as much good to the patient as the removal of the teeth in this 
type of involvement, there seemed definite but temporary im- 
provement; for if a vaccine treatment was given just as the eyes 
were beginning their reaction, the eye involvement was very much 
less severe than regularly developed and the patient largely or 
entirely escaped the subsequent attack of rheumatism, which 
quite regularly followed. 

It is my belief, that this type of patient, in which group there 
is a considerable number, has this strain of germ growing in every 
possible harbor in the system; and that it tends largely to invade 
new harbors. For example, if a pulp should die by trauma or have 
its resistance lowered in this patient's mouth, it would cor- 



CHAP.LXV1 NERVOUS SYSTEM AND SENSE ORGANS EYE 343 

rectly be stated that the blood stream had infected the tooth 

rather than that the tooth had infected the blood stream; and 
also, that these patients are in a state of susceptibility or lcwered 
defense which tends readily, if not regularly, to recurrence of tin 
more acute symptoms. These individuals are probably never 
free from this infection in their blood stream, and unless an acci- 
dent intervene, the progressively lowering defense enables this 
organism finally to cause death, frequently as so-called malig- 
nant endocarditis. In Chapter 20, we have discussed some of the 
characteristics of these individuals from the standpoint of our 
serological studies; and one of the most hopeful signs of improve- 
ment in methods of increasing the defense is from the serological 
aspect. 

In Chapter 34, we have discussed the effect on pregnancy of 
the introduction of streptococcal infection into the blood stream. 
Two pregnant rabbits w r ere inoculated with the strain grown 
from the culture from this patient's tooth (and no difference was 
found in the characteristics of the organisms grown from the 
tooth, the blood stream, and the eyes, in this case). In one in- 
stance a miscarriage was produced. The immature embryos were 
born lifeless in about forty-eight hours. The other rabbit became 
very sick and died in about twenty-seven hours. The fetal forms, 
about half developed, already had been dead several hours and 
were undergoing decomposition. 

Since the above was written, we have made further studies of 
this patient two and three years after the preceding study. She 
has presented because the regular symptoms have continued to 
recur with quite constant regularity, as quite severe exacerbations 
from time to time. Her vision has become progressively more 
defective until it is practically lost in one eye and in the other is 
only sufficient to enable her to distinguish forms but not to 
recognize individuals. Each rheumatic attack is followed by an 
irritation of the eye, expressing itself in pain and inflammation 
with congestion. We have again made a bacteriological examina- 
tion of her blood and find the same organism present in both the 
blood stream and her eye. It is particularly of interest to note 
that with this mild bacteremia, the blood picture is little changed 
from a morphological standpoint. The biologic classification of 
the organisms involved is Streptococcus Non-hemolyticus I. 

This is a remarkable illustration of the saprophytic quality and 
adaptability of this type of organism, for, from this blood study 



34 1 DENTAL IM I t TI0NS& DEGENERATIVE DISEASES CLINICAL VOL. II 

one would not get the evidence without the bacteriological infor- 
mation that she was suffering from bacteremia. 

Just here is another illustration that a new truth is a new sense. 
In Chapter 11 on the Bactericidal Properties of the Blood. I have 
it ported researches that I have been making on the bactericidal 
measure of the bloods of these various individuals, in order that I 
may find a quantitative expression as well as cause for the condi- 
tion of the low defense, by measuring the bactericidal content of 
the mechanisms of the blood for this strain of organism, and also 
to determine the capacity of the blood for its normal reaction in 
the process of defense. This patient's blood has proven to be so 
low that it would be within the poorest 5 per cent, for it neither 
has a normal nor near normal bactericidal quality of the blood 
plasma, nor the leucocytes capable of stimulation to furnish this 
quality to the blood when the same is stimulated by first subject- 
ing the blood to the presence of the dead organisms. These or- 
ganisms have increased their capacity for adaptability while she 
has far below the normal capacity for defense. This immediately 
indicates the point of approach for the improvement of her condi- 
tion and the strengthening of her defense. 

The importance of vision to comfortable life is so great that 
every effort that can be made to prevent blindness is. of course, 
imperative. We present for the encouragement of those with 
similar symptoms another type of progressive blindness which is 
of particular interest because of the very marked improvement. 

Case No. 1111. The patient, female, unmarried, age thirty- 
six, was afflicted with an affection of the eyes, whose chief symp- 
tom was attacks of complete blindness, at first lasting a 
lew moments and later developing into periods of several 
minutes, and at the time she presented had extended to 
ten minutes, with so great frequency that she was afraid 
to go on the street, and was about to be compelled to 
give up her business. She was dependent upon herself 
for her maintenance. She reported that a careful examina- 
tion by a skilled oculist had not given her any encouragement. 
Her eye trouble had been developing, progressively, for approxi- 
mately five years. The history showed that the pathological 
conditions about the teeth dated back to and beyond that time. 
For a year the patient had not been able to do any reading, as 
even a little use of her eyes would bring on the attacks. She was 
in great apprehension of being permanently blind and with no 
means of support. 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS EARS 345 

The condition of her teeth is shown in the roentgenograms 
Figure 444. With the elimination of the dental infections, her 
vision was so greatly improved that her periods of blindness 
entirely subsided and she could spend an entire evening in reading 
without disturbance. In over a year there has been no recurrence 
of the acute symptoms. She has again taken up regular office 
work and the whole outlook on life has changed. 

This case also illustrates another in which there is an exceedingly 
small amount of apical reaction, notwithstanding a considerable 
quantity of dental infection. The lower left first bicuspid had a 
putrescent pulp and the tooth did not have a root filling; yet, 
notwithstanding this quantity of infection, there was practically 
no apical absorption. Similarly, the upper left first and second 
bicuspids with partial root fillings were infected and show, prac- 
tically, no apical absorption, as also the lower right second molar 
and the lower left second molar. 

EARS. 

Probably no lesion of the organs of special sense is more com- 
mon than are those of the ears, particularly in childhood ; and all 
operators will be familiar with many cases of relief of earache by 
the treatment of an irritated pulp in a carious tooth. While these 
lesions are much less frequent in the adult, they occur and are, as 
in childhood, of two types: a sympathetic reflex throughout the 
otic ganglion and auditory nerve, and as a direct toxic irritation 
or bacterial elective localization of the auditory nerve. Such a 
case is the following: 

Case No. 1162. — The patient, male, age sixty-three, presented 
with very acute pain in both ears, more severe in the left. He 
was sent to us by an ear, nose, and throat specialist who could 
not find local cause for the severe suffering. Three teeth, the 
lower left first and second bicuspids ( the latter shown as a broken 
root) and the first molar, were extracted, all with marked con- 
densing osteitis, the roentgenograms of which are shown in 
Figure 445, and the lower right second molar. With the removal 
of these teeth his acute pain stopped abruptly for a few days but 
returned with an infection of the slowly healing sockets, so char- 
acteristic of this type of pathology. With the treatment of the 
sockets, the ear involvement promptly disappeared and did not 
recur. 

For the treatment of these conditions, we have found a solution 
of a very small amount of iodine and creosote, equal parts in 








346 



CHAP. LXVI NERVOUS SYSTEM AND SENSE ORGANS NEURALGIA 347 

eugenol, to be very effective. This may be prepared by adding 
the mixture of equal parts of iodine and creosote, one part to 
eugenol, thirty parts. It is neither necessary nor desirable to have 
the creosote in greater strength than this. An equally good way 
to prepare the dressing is to dip a piece of surgical gauze, one-half 
inch square, into the saturated solution of equal parts of iodine 
and creosote and then carefully wipe off all that can be removed 
by absorbent cotton, and moistening this gauze with eugenol. 
The strong iodine and cresote solution is too escharotic and de- 
stroys the granulations. This dressing works like magic in con- 
trolling the after-pain of so-called dry sockets, which are primarily 
due to the poor vascularization of the alveolus, as a result of con- 
densing osteitis, characteristic of tissue with low defense, and 
found in patients with marked susceptibility to streptococcal 
infection, the local characteristic of which is the absence of nor- 
mal reaction, of which the chief expressions are pain and rarefy- 
ing osteitis, connective tissue proliferation, etc. 

OBSCURE NEURALGIA. 

The members of the laity seem generally to look upon neu- 
ralgias as being pains without a physical cause, or at least not 
due to a localized degenerative process. The reason for this is 
probably largely due to the use of the term by the medical and 
dental professions to include those forms of neuritis for which 
the cause was not known. It is probably true that all disfunction 
as well as malfunction has its counterpart and cause in abnormal 
structural and therefore physical conditions of tissue, for chem- 
ical processes are ultimately physical. Probably few single 
groups of disturbances so frequently have their actual causes 
overlooked as do the so-called neuralgias of the head and face. 
This condition is still further complicated by the fact, that the 
nerve structures involved are very often within dense walls and 
are very difficult to examine except by indirect methods. An 
acute pulpitis will usually present very little difficulty in loca- 
tion because of the exalted reactivity of the pulpal tissue to 
temperature changes. A degenerative process, however, may 
develop within a pulp without considerable change and cer- 
tainly without an exaltation of its thermal reactivity. Many of 
these processes have their origin in other structures than the 
teeth and it must not be presumed that the teeth furnish the 
only source for these obscure disturbances. They do, however, 







t. 



\ 


















f 








%:xh 






' c » 



» 



Ft« < BS( R£ NEURALGIA OF DENTAI ORIGIN: E, CROWNED VITA] TOOTH; D. WITH- 

OUT < R( '■'• N; \. DEGEN1 RATING PI LP WITH CALCIFIC \1I Ns; B, OH SS SECTION OF DEGENERATING 
PULP WITH CALCIFICATIONS; C. HIGH POWER SHOWING HYPEREMIA AND DILATION OF VESSELS 
WITH CALCII [< m< N 

348 






CHAP. I.XVI NERVOUS SYSTEM AND SENSE ORGANS NEURALGIA 349 

furnish very many of them and probably more than any other 
group of tissues. I have undertaken to study the pathology of a 
number of these processes. A typical one will be seen in Figure 
446. The history was about as follows: 

The patient suffered from an obscure pain in the side of her 
head, left side of the face, and neck. This began about a year 
previous to our seeing her and was most severe in the temple and 
the ear. At times the neck stiffened on the left side. There 
were occasions when the disturbance definitely affected her 
thinking. It was progressively getting worse. It began inter- 
mittently and became constant. It was temporarily relieved by 
the extensive use of Balm analgesic rubbed over the entire side 
of the face, neck, and head. It had become so severe as nearly to 
incapacitate the sufferer. All her teeth were roentgenographed, 
and by that means were negative. All tested normally to tem- 
perature change. Naturally, the left mandibular second molar, 
carrying a gold crown, was suspected, notwithstanding the nega- 
tive appearance of the roentgenogram. The history of this tooth 
revealed that there had not been the slightest abnormal symptom 
during the year that the patient had been suffering. Since it was 
difficult to test the tooth with the crown in position, a burr was 
used to drill the dentin at the cervical margin and the dentin re- 
sponded normally. The crown was removed and contained a 
large quantity of cement, into which cement bacterial infection 
practically always extends. There was no recent caries of the 
dentin. The crown had been set without removing completely 
the carious dentin. The dentin was tested in several places after 
the removal of the crown and found to respond quite normally 
to the irritation of cutting with the burr. The tooth was put 
under observation, the patient dismissed, with the result that 
the distressing pain was practically relieved from the time the 
crown was removed, and did not recur. 

In Chapter 17 of Volume One, on Tooth Capacity, I have dis- 
cussed the role of the toxins and their ability to pass through the 
dentin and somewhat of their effects. The bacterial growth in 
cement under a gold crown is very often purely streptococcal, 
and this organism is practically always present. When the or- 
ganisms were growing within this gold crown they produced 
their toxic substances which could not escape through the gold 
but could through the dentin of the tooth and, of course, to some 
extent about the margins. These toxic substances tend to pro- 



350 DENTAL INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL. II 

ducc in susceptible individuals relatively violent reactions in 
proportion to the quantity. The result in this case was not only 
an intermittent involvement of other tissues but it was a direct 
degenerative process set up in the pulp tissue. This pulp de- 
generation can be seen in A. B. and C, in Figure 1 \6. B shows a 
cross section of the mesial root and it will be noted there are ex- 
tensive zones of calcification. A is a longitudinal section of the 
pulp of the distal root and also shows very extensive calcifica- 
tions. C shows a cross section of the pulp under high power and 
shows a very marked hyperemia, extensive fibrosis, and calcifi- 
cations. The development of these degenerative processes within 
the pulp were no doubt contributing to the reflected disturbances. 
However, there was no evidence of pulpal necrosis as a part of 
pulpal suppuration. Its normal reactions to mechanical and 
thermal irritants indicated that it was not a suppurative process. 
Several things are important in this connection. One is that the 
original roentgenogram, as seen in E, reveals what would be con- 
sidered a normal pulp in that there is no periapical involvement 
and the pulp chamber does not give suggestions of calcification 
processes, it being much more clear than the pulps of the first 
and third molars. 

The questions will arise: Why did we extract the tooth? Why 
not remove its pulp and fill the roots? My answer is this: The 
fact that this patient had at one time developed so severe a re- 
action in the nerves of her face and head would make them al- 
ways more susceptible to irritations. Second, the possibility of 
mechanically filling with perfection the mesial roots of lower 
molars is always problematical. Third, it would be impossible 
that the tooth could be put in a thoroughly sterile condition or 
that it could be maintained in as sterile condition as it would be 
left when the root filling was placed. Fourth, it would be very 
probable that in later years, if not months, this tooth would con- 
tain within the dentinal tubuli definite streptococcal infection. 
Fifth, when and if this condition developed, a toxin similar in 
effect to that which was generated in the cement of the gold 
crown would be available and would irritate more or less severely 
the approximating nervous tissues. The tact that this patient 
had developed this type of disturbance would strongly suggest 
that she would do so again. While it is true there would be no 
pull") available to respond to irritation, the pulp is not the only 
tissue that can so react. For those whose practice it is to place 



CHAP. LXV1 NERVOUS SYSTEM AND SENSE ORGANS NEURALGIA 351 

gold crowns, I would urge the keeping in mind the impossibility 
of keeping the cement which attaches the crown from becoming 
infected, the extreme porosity of the dentin, which pores all lead 
directly to the pulp, and the capacity for the pulp as an end 
organ to produce profound disturbances through its sensory 
enervation in the various nerve structures directly and indirectly 
connected with it. 



CHAPTER LXVII. 
SKIN. 

DISCISSION. 

In discussing the lesions of the skin that are related directly to 
dental infections, we are probably dealing very largely with 
anaphylactic reactions to bacterial antigens developed in the 
dental focal infections and to which that patient has become sen- 
sitized. Their variety is so great and the illustrations of success 
and failure so striking that it is, as yet, very difficult to interpret 
either the mechanisms involved or the means for determining, 
in advance, with certainty, whether an obscure dental infection is 
or is not a causative factor. We have discussed this problem in 
Chapter 30 on anaphylaxis, and I will not review at this time my 
interpretation of the principal factors involved. Some of the 
skin disturbances with dental connections are, apparently, true 
bacterial invasions with or without a preliminary irritation and 
sensitization of the tissue by the toxins involved. 

The first case I will present is one of herpes, which is probably 
true bacterial invasion. This patient, a married woman of 
thirty-one years, had been suffering for about five years from 
severe nervous affection, expressing itself in indigestion and in 
skin irritations, typical herpes with a history of herpes zoster, 
with raised areas as large as a quarter which persisted for many 
weeks and were very painful. Her affection was so distressing 
and persisted so long that she confided to me that had it not been 
for her young family who needed her greatly, she felt she would 
have given up the struggle, that she felt there was nothing for 
which to live. Case No. 811. 

Her dental conditions are shown in Figure 447. With the 
removal of the dental infections her improvement was very 
marked and complete. She has gained in weight from about 
125 to 155 pounds, and for three years has not had a recurrence 
of her herpes until a slight one very recently. It seems very 
probable that this woman's dental infections either furnished 
;m antigen to which she was very acutely sensitized, or which 
seems more probable) that they furnished a toxic substance or 

352 



Figure 447. Radiographic 
appearance of dental lesions 
related to an acute herpes 
zoster, which promptly dis- 
appeared after their re- 
MOVAL. Case No. 841. 




bacteria which had a specific affinity for certain nerve tissues, 
particularly peripheral nerve endings. 

We more frequently see skin irritations of dental origin in the 
form of very acute irritation without so much physical expression 
in the tissues. Sometimes there is an itching like the irritation of 
nettles without change in the skin. Such a case is the following: 
Her entire body was itching so painfully that she could not re- 
frain from scratching herself, which, of course, aggravated the 

353 



I DENTALINFEX flONSA DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 448. Upper lateral which, when removed, com- 
pletely RELIEVED A DISTRESSING ITCHING IRRITATION OF THE SKIN. 
Case No. 1114. 

trouble; and, yet, there was very little evidence, physically, of 
the irritation. She found great difficulty in refraining from break- 
ing the skin with her scratching. Case No. 1114. 

An upper lateral tooth, shown in Figure 448, had a history of 
having recently been acutely inflammed with symptoms of peri- 
apical abscess, which symptoms had subsided. The tooth was 
opened for study ; the pulp was found putrescent ; the tooth was 
dressed ; and that night she had by far the most severe symptoms 
of this skin irritation that she had ever had. Its history showed 
that it had a periodic cycle, which would disappear entirely and 
return; but the periods of exacerbation were continually getting 
more severe. This tooth was extracted. This skin irritation dis- 
appeared immediately and has not recurred in two years' time. 
This case should also be considered as probably an illustration of 
sensitization; and it is very difficult to anticipate how far it will 
be demonstrated that these sensitizations have contributed to 
the development of pathological lesions. 

It is not uncommon for us to see the dermatosis, expressing 



CUM'. LXVII SKIN 355 

itself as warts about the arthritic joints, entirely disappear with 
the removal of dental infections; and it is now quite completely 
demonstrated that these proliferations of the epithelium are often 
entirely clue to infection processes. It is not yet demonstrated 
to what extent those proliferative skin irritations, which approach 
malignancy in their type, may be influenced, if not originally 
induced, by some form of allergy. We would present in this con- 
nection for consideration and not as an illustration of a demon- 
strated fact, the following case. 

Case No. 1205. — This woman, age fifty-two, presented with the 
so-called skin cancer of the nose. These neoplasms tend to have 
exacerbations with a definite trend toward malignancy. That 
this lesion may be in part an expression of an allergy is the only 
point we are presuming to illustrate. I have made an extended 
discussion of the researches on this phase in Chapter 31 . She had 
very extensive dental infections, as shown in Figure 179, Chapter 
31. With the removal of these, this skin lesion, which had been 
in an aggravated condition for several months, completely dis- 
appeared, as shown in the pictures which were taken three weeks 
apart (Figure 178, Chapter 31). This lesion had tended to have 
exacerbations but never before had completely disappeared, and 
tended to have its aggravated stage recur in a few weeks' time. 
In this instance it was absent, approximately, five months before 
its return in mild form. I transferred her to a cancer specialist 
to whom I had referred her at first presentation ; and because the 
lesion promptly disappeared after the removal of her dental in- 
fections, she returned the letter of introduction. He gave the 
lesion a treatment with radium, which is very effective for this 
type of lesion, and in several months there has been no recurrence. 

Since the evidence presented in the experimental chapters 
strongly suggests that many of the skin diseases are allergic re- 
actions to protein sensitizations of bacterial origin and other 
forms within the body, many cases would naturally be reported 
under skin lesions which under a strict classification have been 
presented in the chapter reviewing researches on sensitization 
reactions. We would refer to Chapter 30 for the further review 
of the clinical symptoms and their interpretation in relation to 
sensitization. 

Skin lesions about the face and neck may readily be the result 
of a systemic expression of a focal infection or may be the external 
localization of a dental infection probably with direct fistulous 



ill A I \L INFECTIONS & DEGENERATIVE DISEASES t LINICAL VOL.11 

connection with the dental focus. An illustration of the former 
will be that of the girl of twenty-three illustrated in Chapter ! 
who, in addition to her acute rheumatism and heart involvement 
suffered from pustules over her face, in many respects like acne. 
With the removal of her dental infection, not only her rheumatism 
and heart involvement immediately subsided, but this skin lesion 
also. 

There are many lesions, however, of the skin, which seem very 
directly to be connected with dental infections and which are of 
the nature of a sensitization. In Chapter 30 on Sensitizations, I 
presented a number of these. I would, accordingly, stress in this 
connection the type of condition that may be associated or at 
least may be under suspicion as of dental origin. Figure 172, 
Chapter 30, shows a type of scab' dermatitis which is associated 
with so marked a stiffness of the hand and fingers that the indi- 
vidual, a professional pianist, was prevented from maintaining 
his regular duty. There was a marked tendency to deep cracking. 
With the removal of the dental infection, shown in Figure 173, 
this disturbance of six months entirely disappeared, and in seven 
months more has not returned. 

Another type is a dry scaly dermatosis not tending to crack 
deeply, but at times quite strikingly sensitive. It was illustrated 
in Figure 175, Chapter 30. It was present on different parts of the 
individual's body, but chiefly on both arms. With removal of the 
dental infections, as shown, the process entirely disappeared. 
Figure 175 shows this individual's sharp dermal sensitization 
reaction and also the condition of the arm a few days after the 
removal of the dental infections, at which time there was no visi- 
ble indication of where the disturbance had been though it had 
persisted for months previously. 



CHAPTER LXVIII. 

ENDOCRINE SYSTEM. 
[NTRODUCTION. 

A discussion of the lesions of the endocrin system will, of neces- 
sity, involve a reference to much that has already been presented 
in other chapters, since a great deal that has been presented 
in the chapter on Primary and Secondary Sex Organs involves 
the gonads. To save repetition, we will, accordingly, refer to that 
chapter, No. 62, for a further discussion of this. 

GOITER. 

DISCUSSION. 

Attention has frequently been called in literature to the fact 
that dental infections very readily tend to disturb the functioning 
of the thyroid gland. McCarrison in his splendid work in India 
found that he could produce the typical goiter of that district, in 
which he was working, by having the men drink the residue from 
the filtered water of the water supply of the communities where 
this disturbance was so predominant. He also demonstrated 
that the disturbance was more prevalent the farther down stream 
the villages were located, indicating that the increase in the sew- 
age was an important contributing factor. 

Early in our studies, I observed that girls, who were suffering 
severely from enlarged and over-active thyroids, had these aggra- 
vated by the development of dental infections and relieved by the 
elimination of the dental infections. A typical illustration is as 
follows : 

Case No. 628. — The patient, at the age of twenty, had a thy- 
roid which had enlarged her neck to 36 centimeters. She had a 
typical group of symptoms : nervousness, rapid heart, excitability, 
and fear. The condition of her mouth is shown in Figure 449. With 
the removal of these dental infections the circumference of her 
neck reduced to 33.5 centimeters; her nervous symptoms entirely 
disappeared and her heart returned to normal. 

This case is of interest because two years later a tooth which 
I considered to be border-line and had under study because it had 
had an apicoectomy made upon it, developed slight tenderness 

357 



DENTAL INFECTIONS* DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 149. Dental condition related to a case of hyper- 
thyroidism IN A YOUNG WOMAN, AGED TWENTY. D NDITIONS RE- 
TURNED RAPIDLY TO NORMAL FOLLOW INC. THEIR REMOVAL. CASE 62 

though roentgenographically the evidence was not considerable. 
It was kept under study for a few weeks. Her former symptoms 
of thyroid irritation developed with a very marked tachycardia. 
The tooth was removed and her symptoms promptly and com- 
pletely disappeared. 

While a very large number of young girls have thyroid disturb- 
ance, usually with enlargement, throughout all those geographi- 
cal locations that do not have either a soil or water supply from 
the soil bearing shells of salt water fossils or a supply of 
iodin directly from sea water, those cases are not so distressing as 
the acute disturbances of middle life and beyond, which so often 
seriously involve the heart. Such a case is the following: 

Case No. 471. A woman, age forty-two, with three children, 
was suffering distressingly from nervous symptoms, exophthal- 
mos, and very severe heart disturbance. She was not able to take 
care of any of the interests of her home and seemed on the verge 
of a very critical collapse. For the preceding year she had had a 
skin eruption and for a lew weeks had a very distressing cough, 
due to the pressure of her goiter. She had marked tachycardia 
and a murmur had developed some months previous to the lime 
she presented. Her condition was considered too critical for 
operation. 

The type of dental pathology is shown in Figure 150. The upper 
right central had a history of having abscessed five years previ- 
ously, at which time it was treated daily for several .weeks, ten- 
derness lasting for some time following its root filling. An upper 
right molar which had abscessed, had had a root amputated 
about a year previously. At the time of presentation no teeth 
were giving symptoms of trouble. 



CHAI'. I.W 111 ENDOCRINE SYSTEM GOITER 



359 




Figure 450. Roentgenographic appearance of dental conditions of 
very severe case of exophthalmic goiter with heart involvement. 
Patient very rapidly recovered after removal of the dental infec- 
tions. Case 471. 



After the elimination of the dental infections her improvement 
was very marked and rapid. Her goiter reduced in size; the 
exophthalmos disappeared ; and her heart so splendidly improved 
that in a few months' time she was doing her own housework, 
entertaining extensively, and for over three years has been carry- 
ing both her household and social duties with apparent ease. As 
an illustration of her improved heart condition, she does not 
mind a long walk uphill, even when taken rapidly, notwithstand- 
ing she is a very large, stout woman. 

A study of her susceptibility chart shows, as shown in Figure 451 , 
the following: Her disturbances have been chiefly heart, goiter, 
and nervous breakdown. Her severest symptoms have developed 
recently, though she has a history of neuritis and nervousness 
earlier. She had four brothers and four sisters. Two of her 
sisters and one brother have had rheumatism. All of her four 
sisters have had nervous breakdown and her mother suffered 
nervous breakdown three times. One sister is also recorded as 
having a goiter. Both her father and mother have had rheuma- 
tism. However, the chief disturbances have been in the nervous 
system and heart. Her father, three of his four brothers, one of 



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Figure 151. SuscEPTiBiLm record of Case No. .71, with heart %nd goiter involvement 

AND NERVOUS BREAKDOWN. Nell- MARKED HEREDITARY SUSCEPTIBILITY FOR NERVOUS SYSTEM 
AND HEART, WITH -IX DE »THS FROM Till- 1 ATTKK. 

360 



CHAP. 1.. Will ENDOCRINE SYSTEM GOITER 361 

his two sisters, and her mother, all suffered from heart trouble 
during life, and their deaths were recorded as being due to heart 
trouble. The fact that these people did not die young, but in 
after years, would indicate that their heart trouble was one of 
irritation rather than a severe organic lesion. It is very difficult 
to get definite information, as to whether the disturbance, that 
will have been recorded as rheumatism in a member of the family, 
is an involvement of the nervous system as neuritis, or of a myo- 
sitis, synovitis, etc., of the skeletal and muscular system. 

In studying this woman's factor of safety, we should expect it 
to be low in both the nervous system and heart, which, doubtless, 
was a contributing factor to the extreme expressions in those 
tissues of either the direct irritation of the toxic and bacterial 
products of the dental focal infections, or the indirect effect of 
their reaction upon the thyroid gland and the general endocrine 
system. Whatever the mechanism may have been, the extreme 
reactions are strongly suggestive of a very marked sensitization 
and the fact that she recovered so completely and quickly without 
operation illustrates the necessity for careful study to determine 
whether the disturbance of the tissue to be operated upon is not a 
symptom of the focal infection rather than an independent lesion. 

I have no doubt that many, who will look at the roentgeno- 
grams of this woman's teeth, will shrug their shoulders and say or 
think there is little or no roentgenographic evidence that these 
teeth are infected. To these I wish to say that that fact of 
absence of evidence of reaction is one of the saddest I know of in 
connection with all humanity's interests and afflictions, for if 
this woman had an adequate capacity for reaction she would be 
establishing about these seriously infected teeth (for they were 
proven to be infected by culture and animal inoculation) a quar- 
antine against the dental infection which would prevent either it 
or its toxins from reaching the balance of her system. Inciden- 
tally, such an adequate reaction would produce destruction of 
bone which would be replaced by highly vascularized granulo- 
matous tissue and which, of necessity, would readily be recorded 
in the roentgenogram. It is the absence of this reacting capacity 
that is this woman's undoing. As I have shown in other chapters, 
the most important factor is the capacity for reaction of the 
patient, and an understanding of its expressions. 

In our animal inoculations it is not unusual to find very marked 
involvement of the endocrine system. Such a case is the following : 



362 Dl. M \L1M-Lc riONSfi DEGENERATIVE DISEASES CLINICAL VOL.II 




■ 



Figure 152. An enormously hypertrophied thymus which developed in a 
rabbit inoculated with a dental culture. 

Rabbit 156, shown in Figure 452. was inoculated with the culture 
from a patient with streptococcal blood stream infection with 
multiple symptoms, including rheumatism, eyes, heart, nervous 
system, and skin. This figure illustrates a greatly enlarged 
thymus as the result of this incculation. We do not interpret this 
to indicate or even suggest that this patient had a thymus involve- 
ment. We do net know; but present the case only as illustrating 
this extreme effect upon this rabbit, a lesion which has seldom 
occurred to so great an extent. To what extent this patient's 
symptoms of endocrine derangement were the result of thymus 
irritation we cannot even guess. 

PANCREAS. 
In the chapter on Chemical Changes in the Blood. I have dis- 
cussed some of cur studies on the relation of dental infections to 
pancreas function and carbohydrate metabolism, and have shown 
that dental infections tend distinctly to increase the sugar reten- 
tion in the blood in experimental animals in certain instances. 



CHAP.LXVII1 ENDOCRINE SYSTEM PANCREAS 363 

Since carbohydrate metabolism is so closely related to, and 
dependent upon, the functioning of the islets of Langerhans of the 
pancreas, it seems very probable that any process, which may 
disturb the normal functioning of that tissue, will in turn disturb 
both carbohydrate metabolism and acid-base balance. The proc- 
esses that are involved in these disfunctions, while not clearly 
understood, have been greatly elucidated, as shown in Chapter 20, 
by the researches of Banting', Best, Collip, Hepburn, and Mac- 
leod. 

It is, of course, impossible for us to present evidence to establish 
definitely that the dental infections per se have been responsible 
for the disturbance in carbohydrate metabolism by producing a 
lesion in the pancreas of the patient. We can, however, be justi- 
fied in making some observations which will relate the patient's 
clinical condition to carbohydrate metabolism. This has ex- 
pressed itself with a marked diminution of a hyperglycemia, 
coincident with a reduction of the glycosuria, which has occurred 
in a number of instances. In Figures 192 and 193 there 
will be seen two specimens of pancreas tissue; 192 is taken 
from a normal rabbit and 193 from a rabbit inoculated with a 
strain taken from a dental infection. It will be noted 
that there has been a distinct change produced in the islets 
of Langerhans in these two tissues. Of course, it is not 
possible to take a section of a pancreas from a rabbit 
and then inoculate it and later take some of the same 
tissue. We are presuming that the rabbit selected as normal had 
a normal pancreas, which was evidenced by the fact, that in a 
large number of sugar determinations of normal rabbits we have 
never found any divergent from the normal though we have fre- 
quently found this factor distinctly disturbed by the inoculation, 
as cited in Chapter 20. It is my belief that further research on 
this important problem will disclose further evidence of this 
relationship. 

5 See bibliography. 



CHAPTKk LXIX. 
OTHER TISSUES. 

DISC USSION. 
I nder the head of other tissues we will discuss a variety of 
tissues not included in the foregoing subdivisions, first of which 
will be the salivary glands. The involvements of the parotids, as 
parotitis or mumps, is familiar to all as an acute infection of 
relatively short duration and, except for the complications, is not 
frequently serious. Acute parotitis has frequently been produced 
by dental infections and the organism found in mumps has been 
classified as a strain of streptococcus. This, however, is net the 
type of lesion that is of greatest concern; not because it is not 
severe, but because it is not frequently serious, and its duration 
is relatively short. 

XEROSTOMIA. 

This disease has been considered relatively rare and its etiology 
has been unknown. It is fortunate it is rare because its fatality is 
so very high. There are only a few dozen cases of the disease in 
the medical and dental literature, and, so far as we know, prac- 
tically all have proved fatal. 

Its cause has been supposed to be in the central nervous system. 
The symptoms are a lack or absence of the normal secretions and 
dryness of the mouth, increasing in severity until the tissues 
crack, suppuration sets in, and the patient dies a most agonizing 
death. The first case we will study is as follows: 

I 'use No. 955. — A woman, age fifty-seven. Her history showed 
that she had rheumatism which began acutely fifteen years pre- 
viously. At the time of presentation her joints were swollen and 
her hands could not be closed. She had had acute indigestion 
which produced fainting, on two occasions. A heart lesion had 
developed thirty years ago with la grippe. Her dry mouth began 
eight years previous to my examination. At this time it was 
parched so that it was like feeling a piece of dry tissue paper. 
The tongue and the inner surface of the cheeks cracked readily. 
There was complete absence of both mucous and salivary secre- 
tions. Owing to the fact that we could find no reference to the 

364 



CHAP.LXIX OTHERTISSUES XEROSTOMIA 365 

development of the pathology or its etiology, I removed a part of 
the right sublingual gland for histological study and also some 
mucous membrane from the cheek for similar study. 

A characteristic of these cases is the persistent and rapid caries, 
the crowns just melting from the roots, requiring almost weekly 
care; and in this patient's case it had only been because of the 
exceeding faithfulness of her dentist that any teeth were left. 
It is necessary for these patients to take water into their mouths 
very frequently in order to moisten the tissues. As the disease 
develops, the dryness extends to the throat and eyes, the latter as 
xerophthalmia. 

By manipulation of the parotid glands and compression of the 
cheeks, it was possible to cause to exude from the Steno's duct a 
small quantity of a gelatin-like mass which was so dry that it 
would not moisten a cover-glass or mirror. Culturing of this 
mass always produced streptococci, growing chiefly in diploid 
form. Owing to the dryness of her mouth, it was very difficult to 
get roentgenograms, since the dry tissue tended readily to be 
lacerated and healed slowly from laceration. 

On sectioning the tissue taken from the sublingual gland, very 
definite structural changes were found, as shown in Figure 453. A 
shows a normal lobe and lobule, and B one as found in her tissue. 
Note the degenerative necrosis of the lobe, with its infiltration 
of leucocytes, degeneration of the excreting cells, necrosis and 
fibrosis with a tendency to proliferation so pronounced as to be 
even suggestive of malignancy. A high power view of this tissue 
is shown in Figure 454, and of lobules of other cases in 455. 

The roentgenographic studies of her teeth are shown in Figure 
456. It will be observed that the lower left first molar gives evidence 
of a curved, if not a deformed root, which condition had presented 
great difficulties to the operator who undertook to fill it. This 
tooth was extracted, at which time it was found that the mesial 
root was bifurcated, as shown in Figure 456. This is a very unusual- 
condition and is not disclosed in the roentgenogram. One branch 
of this bifurcated root did not have a root filling. The tooth, due 
to the mechanical difficulties, had not permitted the root filling to 
be placed to the end. 

The history of this and similar cases had been that the use of 
sialogogues was not beneficial. The placing of the whip on these 
exhausted tissues was always followed by the making of the con- 
ditions more aggravated than before. This had been tried many 











-f* 




- 




Figure 153. i pper, n irmai sublingi \' gi wd showing i obe and duct and numerous 

NORMA! 1 V FUN< M MING LOBULES OR ACINI; 1 OWER, PATH ILOGICAL SUBLINGUAL (.LAND OF 

Casi No 955, sh iwing degenerated lobe. The lobules, or acini, are nearly all 

DESTROYED, \ FEW INTACT BUT BREAKING DOWN. 

366 














Figure 454. Xerostoma (dry mouth) section of sublingual gland of patient, Case 
No. 955, showing a chronic proliferative interstitial inflammation, with necrotic 

DESTRUCTION OF ACINI. THE INFECTION IS WITH DIPLO- AND STREPTOCOCCI. 



[OTHER TISSUES XEROSTOMA.] 

367 



CHAP. LXIX ALL OTIIKK TISSUES XEROSTOMIA 



369 






r i 



o. 





'V\ 








I 







Figure 455. Typical degenerative necrosis of sublingual glands of different cases of xerostomia. 



370 DENTALINFEX I l« »NS« DEGENERATIVE DISEASES i LINK AI. VOL. II 




Figure 156. Xerostomia. Case No. 955. A. roentgenocraphk appearance 

OF LEFT MANDIBULAR SECOND MOLAR; B, PHOTOGRAPHIC APPEARANCE OF BEFURCATl 
MESIAL ROOT; C, HYPERTROPHIED I OBU1 ES OF PATEEN1 'S SI Bl IM.i \i 1,1 \\i>. 

times and always failed, and always seemed to leave the condition 
worse than previously. Since cultures taken from the glands al- 
ways produced the same organism in pure culture, and since the 
same organism was found in the root of the extracted tooth, it was 



CHAP.LXIX OTHERTISSUES XEROSTOMIA 371 

deemed wise to use an autogenous vaccine made from this organ- 
ism as grown from the tooth with the hope of boosting the pa- 
tient's defense. 

Studies of the blood showed hemoglobin 80 per eent on four 
occasions, and the erythrocytes varied from 3,400,000 to 
4,400,000, and the leucocytes varied from 12,000 to 21,000. The 
mononuclears, when we started our vaccine treatment, were 18 
per cent, and the Arneth Index was very low. After the use of the 
vaccine, the hemoglobin advanced to 90 per cent ( and later to 95 
per cent), and the erythrocytes to 5,200,000, and the leucocytes 
remained at about 12,000 to 13,000. The mononuclears reduced 
1 to 5 per cent; the Arneth Index improved. 

The effect on the secretion of moisture was definite. The 
material exuded from the ducts frequently without much effort. 
The general condition of the mouth w r as more moist. For the 
first time in a few years she was able to lick a postage stamp and 
seal a letter; and also for the first time in a few years, she had 
enough moisture in her mouth to swallow when awakening. 
When talking or otherwise keeping her mouth open, it rapidly 
dried out so that it was nearly as dry as the surface of her face. 
It was necessary for her to avoid continued conversation, public 
speaking, etc. 

While this patient had been treated in several of the best insti- 
tutions of the country, she stated that, practically, no improve- 
ment had been made ; in one, after studying her case for a couple 
of weeks, she stated that they advised her that since there was 
nothing known about the disease, all they could do was to give 
her the Greek name of it. The evidence at hand strongly sug- 
gested that the patient was suffering from a streptococcal infec- 
tion of both the salivary and mucous glands, with the resultant 
necrosis and toxic poisoning which was progressively advancing. 

In order to determine whether the organisms secured from 
these diseased glands had elective localization qualities for those 
tissues, several animals were inoculated with these cultures with 
the result that in many instances extensive involvements of the 
sublingual, lingual, and submaxillary glands were produced. 
Figure 457 shows in A a sublingual, submaxillary, and parotid 
gland of a normal rabbit in the upper row, and in B the corres- 
ponding glands as removed from one of the experimental animals, 
in which it will be seen that they are practically doubled in size. 
In Figure 458-B there is shown a dissection of the sublingual glands 



372 DEN1 M.lMI.c I [ONS« DEGENERATIVE D] ( LINK M. VOL II 






k 




B 



Figure 157. Sublingual, submaxillary, and parotid 

GLANDS: In A. FROM A NORMAL RABBIT; IN B, PROM A RABBIT 
INOCULATED WITH A CULTURE FROM A To:)TH SHOWN IN !.".»). 

in another rabbit, enlarged and exposed in situ, and in A an 
acute suppurative arthritis produced in the same animal, which 
is a common complication with this disease. 

Another patient suffering from xerostomia in a more aggra- 
vated form, if possible, has shown on section of a piece of her 
sublingual gland (See Figure 459 1 the same general pathological 
changes, as seen in Figure 454. In A will be seen one of the func- 
tioning tubules, enlarged and degenerating, and in B the extensive 
degeneration and necrosis of the secreting acinus. In one of the 
rabbits inoculated with culture from the gland exudate, which at 
times was purulent, most profuse involvement was produced in 
the sublingual gland with hemorrhage and infected areas about 
to break down with necrosis, as shown in Figure 460. 

The prognosis of these cases is always bad. I [owever, we have 
more hope from the result of another case that has been under our 
observation which was of shorter duration (approximately one 
year since its onset) and which under treatment with removal of 
dental infection and the use of cod liver oil returned practically 
to normal. This I administered on the presumption that since 
xerophthalmia, a similar dry affection of the eye developing into 
suppuration, is influenced, if not produced, by the absence from 
the food of a special fat soluble vitamin which is found abun- 
dantly in cod liver oil, that substance might be of benefit in thi 




Figure 458. B, a pair of greatly hypertrophieo sublingual glands produced in a rabbit from cultures 
from Case No. 9o5 with xerostomia and rheumatism. A, an acute suppurative arthritis in same rabbit. 



373 







Figi re 159. Se( rioN of sum inguaj gi and from Case No. 1136, suffering from xerostomia. 
Note marked degeneration of vcinus \nd secreting lobule. 

374 



(.'11 \1>. 1..X1X OTHER TISSUES ORAL HERPES 



375 




Figure 460. A suppurative and hypertrophied sublingual gland of a rabbit inoculated 
from Case No. 1 136. 

cases. Figure 461 shows a histological section of a piece of the sub- 
lingual gland of this patient in which it will be seen that the de- 
structive changes and necrotic processes had not progressed nearly 
so far as in the preceding cases. 

While, so far as we can find in literature, this is the first sug- 
gested interpretation of the pathology based on either dissections 
of the glands of the patient or animal experimentation, we do not 
feel that the explanation is so simple as a simple bacterial invasion 
of a streptococcal strain having elective localization for this 
tissue. Because of the marked beneficial effect in the last case 
cited of the use of cod liver oil, it seems very probable that the 
bacterial invasion is either related as a destructive factor to some 
essential hormone which is concerned with salivary and mucous 
production, or that such a substance has a counter part to some 
extent in the fat soluble vitamins, whether A or D, or some other 
with which we are not familiar. 

ORAL HERPES. 

It is not uncommon either in association with dental infections 
or following operations for their elimination, that patients are 
affected with herpes which may extend over a considerable area 
or be limited to local zones. The local structural pathology of 
this condition has been obscure. Our histological sectioning of 
these tissues has shown a diplo-streptococcus growing within the 
tissue. These tend to produce minute subepithelial abscesses 



376 DENTALINFEC ttONS& DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure 161. Section of sublinguai gland of Case No. 1185. suffering from xerostomia. 

Snow-- A DEGENER \TI\I- LOBUI I WITH FIBROSIS. 



CHAP.LXIX OTHERTISSUES DENTAL CYSTS i>77 



c vs. 










» 






.-*■ t'- ■ 



Figure 462. Oral herpes. An acute streptococcal abscess beneath the 
epithelial layer of the mucous membrane. 

immediately beneath the epithelial layer of the mucous mem- 
brane. A cross section of one of these is shown in Figure 462. 

DENTAL CYSTS. 

Probably no single dental lesion presents more obscure and at 
the same time serious systemic involvements than do dental 
cysts. It is probably because of the subtleness of the involve- 
ments that they are so generally overlooked except as they are 
accidentally found in general roentgenographic procedure. As an 
illustration of the extreme severity of the symptoms that they 
may produce, I present the following case. I was called at night 
to see a boy of about fifteen years of age, who had so acute a heart 
involvement that his pulse was running at 160, with very marked 
dyspnea, and conditions getting so progressively worse that I was 
called in consultation with his physician who was unable to find a 
contributing factor that could account for the extreme involve- 
ment. 



378 DEN] U. INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 



An examination of his mouth disclosed that a deciduous cuspid 
had been retained and gave a history of complete freedom from 
local inflammatory processes. Over the position of the unerupted 
cuspid there was a tumor-like mass, entirely free from tenderness 
on pressure. A careful examination of the deciduous cuspid re- 
vealed that the pulp was non-vital. I decided that the tumor-like 
mass was a cyst and, accordingly, under a local anaesthetic per- 
forated its bony wall and evacuated a quantity of cloudy cyst 
fluid not at all purulent. Later a roentgenogram was made of this 




Figure UxS. a dental cyst which pro- 

in CED A VERY ACUTE HEART INVOLVEMENT IN A 
BOY ok FIFTEEN. PULSE RATE DROPPED PROM 

160 To SO IN A FEW HOURS AFTER EVACUATION OF 
CYST. WITH RAPID AM) COMPLETE KKCOVKKV 



condition, which is shown in Figure 463, with the cyst chamber 
surrounding the crown of the permanent cuspid. In a few hours' 
time this boy's heart rate was down to approximately half its rate 
for the twenty-four hours preceding this evacuation; and, though 
it was taken several times in the next few days, was never found 
above 90. That this cyst fluid contained, and was elaborating a 
toxic substance which had an elective localization for irritating 
his heart is very strongly suggested by his and several other cases. 
This boy has two brothers, both of whom have had heart involve- 
ment. His father died of heart involvement, and the evidence 
indicates that he has a predisposition, therefore, for sensitization 
affects or irritation of that tissue. 

Sometimes the cyst elaborates a substance which produces an 
effect on an individual very similar to that of cerebral hemor- 
rhage. Such a case is the following: This patient, at seventy- 
five, was brought by a physician with the statement that one foot 
was in the grave and that I must be very careful. His life had 
nearly passed out several times with an affection similar to a 
stroke. This affection would sometimes have a motor expression 



CHAP. 1. XIX OTHER TISSUES DENTALCYSTS 379 

only, as, for example, on one occasion when he went to walk 
toward the door, he involuntarily would turn to the right, a 
direction he did not wish to go and keep on walking, resulting in 
a circular movement. This would happen sometimes in the house 
and sometimes in the street. At times his speech would be 
thickened for a few hours. His blood pressure would vary from 
very high to very low in a short period of time. 

A mcst important and significant incident happened in con- 
nection with the care of his case. A local anaesthesia was used 
for the drainage of this very large cyst, which had its origin be- 
neath the lower left bicuspid and extended from the molar region 
on the left to the cuspid on the right, with the denudation of the 
roots and the devitalization of all the intervening teeth. Prior to 
his being brought to me, he had had an involvement which had 
kept him in bed for a day, similar to a stroke, involving his entire 
left side, including his speech. The operation, which I used for 
the drainage of this cyst, involved a liberal opening which un- 
covered the inferior dental nerve and blood vessels passing 
through the floor of the cyst ; and in order that these might not be 
destroyed, the procedure involved the extending of the mucous 
membrane of the mouth to include the entire cyst chamber and 
thereby displace the pathologic membrane lining that orifice, 
sections of which are shown in the discussion of the next case. The 
chamber was, accordingly, packed lightly, while under the anaes- 
thesia, to protect the sensitive structures. When this packing 
was removed on the following day, the reaction on the patient 
was to bring on instantly all the symptoms of a cerebral hemi- 
plegia, which involved all of the motor control of his left side, 
including his speech. This paralysis was so complete that his foot 
and arm hung lifeless by his side. This paralysis lasted several 
hours. 

A mcst remarkable factor in connection with these cysts is that 
mechanism of the progressive absorption in advance of the pyo- 
genic cyst membrane. In this instance, as I have stated, all the 
teeth from the lower left bicuspid, abcut the apex of which the 
cyst started, to the lower right cuspid, had their apices denuded 
and were, accordingly, devitalized. Photographs of them are 
shown in Figure 464. 

Two things are important in this case. The first is that the 
heart block and disturbances of arterial tension quite completely 
disappeared. Another is that notwithstanding this man's far 



380 l.l.M \L INFECTIONS & DEGENERATIVE DISEASES CLINICAL VOL.11 




FlGUM 164. iDENTAJ CYST WHICH STARTED WITH THE LEFT MANDIBULAR 
Uli l SPIDS AND EXTENDED TO Till- RIGHT CUSPID, SHOW N IN A \\l> B. (.' SHOWS 
nil ABSORBED ROOT APICES OF 1 1 II I OWER IV ISORS \M>I EFT CUSPID. PATIENT, 
SUFFERING] ROM 111- \KT HI < *. K \\n SYMPTOMS OF STROKE, HAD A REMARKABl I 
RECOVERY, 



CHAP. l.XIX OTHERTISSUES DENTALCYSTS 



381 





- 
--■ 
< 
a, 
O 

DC 





Figure 166. Orai appearance of cyst shown in A. B, entrance made to the cyst in the 
orai cavity. Case No. 1098. 

382 



' 



CHAP. I. XIX OTHER TISSUES DENTAL CYSTS 383 

advanced age, in a few weeks' time he was able to walk five to 
ten miles without tiring, and for about three years has had most 
remarkably good health. 

In another chapter, Figure 390, Chapter 65, I have shown 
a third molar that was pushed from its normal position nearly 
to the base of the condyloid process. This process of pressure 
may produce an extreme distortion of tissue, even to the extent 
of very serious facial deformity. Such a case is shown in Figures 
465 and 466. This man, age forty-two, had a dental 
cyst developed to the enormous size shown in Figure 
465- B, which is a roentgenogram, reduced size, of the 
cyst chamber temporarily packed with an opaque gauze. 
This chamber developed, pushing its walls in all directions 
until the maxillary sinus was entirely obliterated, the right 
naris was nearly obliterated, the eye was bulged, and the 
floor of the orbit pushed upward. The cyst extended mesially to 
the eye, up about two centimeters higher than the floor of the 
orbit. A digestive disturbance was an important factor in this 
case. 

A section of the cyst membrane and bone adjoining it, is shown 
in Figure 467-C ; and it will be seen that the osseous structure is 
being torn down by the osteoclastic cells as the hydrostatic 
osmotic pressure pushes the pathogenic membrane closely against 
the tissue and reestablishes, continually, the pressure reaction 
which on the outer surface of this membrane results in the taking 
down of bone. The content of this and similar cysts is shown in 
Case No. 978 in the chapter on Skeletal and Muscular System. 

In all these cases it is necessary to maintain a free opening into 
these chambers for sufficient time to permit the mucous mem- 
brane of the mouth to extend to all parts of the cyst chamber and 
make the new chamber a part of the oral or some other natural 
cavity, at least for a considerable period of time. Both because of 
the great size of this cyst, which made the surgical development 
of a connection with the oral cavity very simple, and because of 
the necessity for maintaining this opening and at the same time 
preventing the passing of food into this chamber, the dental 
restoration that was made carried a huge plumper which passed 
up into the face nearly to the eye, into the zone formerly occupied 
by the maxillary sinus and now a part of this cyst chamber. Re- 
sults have been exceedingly gratifying, if not ideal. The external 
facial deformity has rapidly disappeared, for his cheek was badly 
bulged and the eye displaced, as shown in the photograph. The 



384 DENTALINFEC 1 IONS4 DEGENERATIVE DISEASES ( LINICAL VOL.11 










— - SJ' - 

rz-' ■ -' 




*; . 



4 



fc v 



« 



k-^^k 



lli.i re 167. a. a roentgenographic view, b, artificia1 denture and splint to support the de- 
stroyed cheek honk and permit orai ml co! s membrane to extend and displace all cyst tissues. 
resu1 ts excel! ent. c, section of honk adjoining advancing cyst. note the active osteoclastic 
process. Case No. 1098. 

cyst chamber has slowly reduced in size and he wears this restora- 
tion with complete comfort and masticating efficiency. 

A phase of this case is of particular importance. I have been 
advised that arrangements had been contemplated for a major 
operation, entering this zone from the external surface to remove 
a malignant tumor. Our method of study in this case, as in 
many of these cases where there is any doubt regarding the con- 
tent, is to make a microscopic examination of aspirated material. 



CHAP.LXIX OTHERTISSUES DENTALCYSTS 385 

which in this case readily revealed the nature of the cyst. When 
cholesterol accumulates in these cysts to a concentration in which 
the osmotic pressure is greater than the osmotic pressure of the 
lymphatic circulation and of the blood stream, there is a flow of 
serous fluid to this salt of higher concentration in the pathological 
fluid than in the blood fluids. The membrane lining the cavity 
takes on a state of semipermeability, allowing the serous fluid to 
pass readily into this chamber, but not allowing the cholesterol 
to pass out. There is, in consequence, an ever enlarging chamber, 
which, by its own hydrostatic pressure, pushes back all flexible 
tissues, and by pressure on hard tissues accomplishes their 
absorption. It is a force analagous to that which makes plants 
grow. 

The history of this case shows that four years prior to his being 
brought to me he had suffered a toothache on the right side 
of his face and had presented for treatment for same, a part of 
which included the placing of a bridge on the affected root. The 
symptoms reported indicated that he had suffered from an ab- 
scessed root. The evidence available seems to demand the 
general recognition of the fact, that teeth, and particularly roots 
of teeth, with an involvement for sufficient length of time for the 
peridental membrane to be destroyed at the apex of the tooth, 
will produce a condition which will in most instances constitute a 
potential factor of danger in that there is no evidence available 
that the cementum, when once denuded and devitalized, will ever 
again permit of the normal attachment of tissue ; nor is there evi- 
dence that such tissue, even though it may be sterilized, w'hich is 
questionable, can be retained in a sterile condition. Cyst material 
taken from this patient and inoculated into rabbits, produced the 
serious heart involvement of the rabbit shown in Figure 468. The 
patient complained of a marked lassitude, which symptom quite 
completely disappeared with the drainage of the cyst. 

But dental cysts seem also to produce toxic substances which 
have a marked affinity for nerve tissues, and whether or not grav- 
ity is a chief factor, it seems probable that it is a contributing one 
since the cervical nerves are more readily involved with toxic in- 
vasion than those of any other part of the body. A most logical 
route for the toxic material developing under pressure from den- 
tal abscesses or dental cysts will be through the lymphatics 
draining that area, and these have a very wide anastomosis into 
the neck and thoracic cavity. A striking illustration of this will 






386 DENTALINFEC HONS& DEGENERATIVE DISEASES CLINICAL VOL.11 




Figure i« : h. Heart of a rabbit with endocarditis 
produced by the inoculation of culture prom case 
No. L098. 

be found in Case No. 978. Photographs of this patient's lesion 
are shown in Figure 367, Chapter 64, on Skeletal and Muscular 
System. The cyst in that case was in the maxilla. The most 
striking feature of it was that a lesion, which had dominated and 
greatly diminished the efficiency of this individual for many 
months, was greatly relieved within five hours after the draining of 
the cyst. It is also important that these symptoms returned at 
one time during which he failed to maintain drainage when the 
artificial substitute, which was closely adapted to keep food from 
getting to the chamber, was left in position for several days, the 
result of which was the development in the chamber of the char- 
acteristic cyst fluid, with a concentration of cholesterol and ether 
substances, and which symptoms rapidly disappeared again with 
the complete irrigation and reestablishment of the proper treat- 
ment. The inoculation of a rabbit with the material contained in 
this cyst produced an acute involvement with the spasmodic con- 
traction of the hind leg, which is shown in Figure 367. 

In the chapter on Digestive Tract Disturbance. I have dis- 
cussed a case of extensive cyst, to which I have just referred, 
in which the third molar was pushed backward and upward See 
Figure 390). In that case the patient was suffering from a very 
acute digestive tract disturbance. The significance, then, in 
that case was that the patient had a colitis with evacuations on an 
average of every thirty minutes. Rabbits inoculated with the 
content of the cyst of that patient developed acute diarrhea in 
about forty minutes, and several of them developed very severe 
colitis, and. on posting, had extreme distention of the colon with 
typical spastic colitis. 



APICOECTOMY. 

It will not be possible to cover all of the involved phases of 
dental practice in this general analysis of the fundamentals of oral 
and clinical dental pathology. It is, however, important to em- 
phasize again the type of individuals for whom certain opera- 
tions should be considered more favorable than for others. It is 
not necessary for me to review here why individuals, with a 
broken defense or who by inheritance have never had a normal 
defense for streptococcal infection, should not have produced in 
their bodies conditions which can furnish the type of organism 
which even in small quantities may bring upon them their most 
to be feared disaster: namely, a streptococcal involvement of an 
essential organ or tissue. These individuals should in my judg- 
ment have all questionable teeth removed, by which I mean teeth 
that modern science cannot demonstrate not only the capacity 
of the operator with certainty to make them free from infection, 
but the capacity of the patient carrying them to maintain them 
in a sterile condition, assuming they have been made so; in other 
words, individuals with any of the following — a serious heart, 
kidney, or central nervous system involvement — not only should 
not have root-filled teeth left in their mouths, but should not have 
involved pulp chambers of teeth of such individuals root-filled. 
I am presenting this as my best judgment and I will ask those, 
who with perhaps a great deal of enthusiasm challenge my posi- 
tion, to measure carefully whether they have as good a basis for 
judgment in dental pathology as I am presenting in these vol- 
umes. If so, I would greatly desire that they will put me in 
touch with the data. 

Nor is it my judgment that individuals with these serious 
handicaps of broken or absent defense should have the operation 
of apicoectomy with the expectation that these teeth will be safe. 
In the thousands of teeth that we have cultured from various 
individuals, a very large number of which were from individuals 
of this group, we have not found one in one thousand from the 
inner structure of which we could not grow streptococci. The 

387 













1 169. R] ACTIONS ON A RESECTED TOOTH: A, LOW POWER VIEW OF STUMP; B, ABSORPTIVE MEMBRANE 
MEDIUM POWER; C, OSTEOCLASTIC ACTIVITY ABSORBING TOOTH. 



CHAP 1 \l\ OTHER TISSUES VPICOECTOMY 389 

problem, therefore, is not solved by placing a root-filling and 
taking off the apex. If, however, root resections are to be made 
with the expectation that they will conserve a very valuable 
tooth and therefore render an important helpful service, they 
should be made for those individuals with a high defense; and for 
those who are in a mood to resist or react against the sentiments 
I am expressing, I will ask them to turn quietly to Chapter 64 of 
the second volume or Chapter 41 of the first volume, and note 
the difference in the bactericidal properties of bloods of individ- 
uals of these two groups. These people only look alike because 
of our inability to see what they look like ; and in no department 
of dentistry is a new truth so truly a new sense as in this matter 
of being able to see people more nearly as they are, than we have 
been accustomed to do when we used as our glasses comfort and 
serviceability as the evidences of efficiency and defense, and free- 
dom from infection. With this new sense, these have little or no 
weight when compared with the bactericidal capacity of the 
blood, etc. 

There is, therefore, an exceedingly great difference in the re- 
action that will be made by different individuals about either an 
infected root or an infected root apex. Individuals of one group 
make almost no effort and show by the results almost no capacity 
for neutralizing the toxic products, whereas those of the group of 
high defense may show a very great effort to get rid of and neu- 
tralize the toxic irritant. This will be illustrated in Figure 469, 
which shows three views of a root apex under different magnifi- 
cations, demonstrating the activity of the host in trying to re- 
move the infected root. A shows a cross section of a tooth from 
which the tip had been resected some months previously. The 
light line in A shows the zone removed for sectioning in B. In B 
it will be seen that a membrane has been formed over the excised 
surface which is showing a marked activity in absorbing the root, 
which to the host has become a sequestrum, for whether we are 
ready to acknowledge it or not, the dentin at least of every pulp- 
less tooth is a sequestrum and often an infected sequestrum, but 
different from an ordinary sequestrum in that it is surrounded in 
part or in whole by vital cementum, which latter is surrounded 
by vital supporting tissue. Unfortunately it seldom, if ever, is 
true that it is surrounded in whole by vital cementum. Since the 
foramen or foramina become port holes of exit for toxins, and 
usually for bacteria, even though the dentino-cemental border 



390 DENTALINFEC HONS& DEGENERATIVE DISEASES CLINICAL VOL.11 

may be impervious to one or both. In C, which is a higher mag- 
nification, we see the osteoclasts actively engaged in the proo 
of taking clown the tooth structure to remove this tooth. 

The type of individual that produces this type of reaction is 
carrying the fight right up to the point of contact and is closing 
in upon and making smaller the boundaries of that contact by 
tearing down the foreign process. In individuals of the groups 
with lower defense, we do not get this type of reaction. The fight 
is not carried up to the tooth, for little, if any, fight goes on im- 
mediately surrounding the tooth but must ultimately be waged 
far afield from this (the proper) battleground in the various or- 
gans and tissues of that individual's body. Xor does the pres- 
ence of such an active process guarantee that this patient will 
always be safe from injury from this type of involvement. It is 
very probable that this type of reaction will mean for the in- 
dividual who can make it, a tender tooth, as it did in this case. 
Comfort is not a measure of safety or assurance of success. It 
may mean just the opposite. 



THE REPAIR OF DENTIN AND CEMENTUM. 

Of all the structures of the body the teeth have the poorest 
capacity for repair. So far as I know there are no acceptable 
data demonstrating that a cavity of caries in enamel and dentin 
has actually been rilled in by a normal tooth structure. I have 
seen cases where this was alleged to have transpired but I think 
they were mistaken. The very nature of these structures and 
of their formative processes precludes a reparative process except 
in vital tissue, and carious enamel and dentin cannot be con- 
sidered to be vital. When, however, an injury happens to vital 
dentin and cementum, a reparative prccess may occur. This 
most frequently occurs at the pulpal surface of dentin, due to 
peripheral irritation, and produces a secondary deposit of dentin 
within the pulp chamber, which may very efficiently protect the 
pulp tissue from the disturbing irritant. When irritation dis- 
turbs the cementoblasts, they too may throw down a deposition 
of cementum, structurally quite similar to the normal. In the 
chapter on Skeletal and Muscular System in the discussion of 
Osteomalacia, I have illustrated different types of reaction in 
bone in patients of different groups. The process of building up 
and taking down cementum is dependent upon physical forces 
and may be physiologic or pathologic in accordance with con- 
tributing factors. In the treatment of periodontoclasia it will 
be a matter of exceeding great value if, in addition to checking 
the progressive destruction of the supporting tissues, they can 
be made to rebuild. I have demonstrated to my complete satis- 
faction that this process can occur, though I am convinced that 
the conditions necessary for it to take place extensively can be 
secured only relatively rarely. 

In the case of a fracture through a vital tooth root, if the pulp 
tissue remains in situ, the dentin of the root may remain vital, 
the peridental membrane may fall over the fractured dentin and 
may build up on the root an osteoid structure. Such a case is 
shown in Figure 470, in which A shows the roentgenographic ap- 
pearance of a long imbedded mandibular third molar root. B 

391 



392 DENTALINFEC HONS& DEGENERATIVE DISEASES CLINICAL \()L.1I 





Figure 170. An vpparent repair of dentin op an overgrown third molar root 
1111 i'.v \ previous extraction: a. roentgenographk appearance of root in 

MANDIBLE; 15. ROENTGENOGRAPHK VPPE FRANCE OF IMBEDDED ROOT; C, SECTION THROUGH 
MES1 \i and BUCCAL ROOTS. 



CHAP, I. XIX OTI1KK TISSIKS DKNTIN \ CEMENTUM REPAIR 393 

shows the roentgenograms of the root when surgically removed, 
and C a mesiodistal section through the two roots. It will be 
noted that there has been considerable excementosis by a process 
of successive laminations, greatly increasing the size of the root. 
The pulp chambers were filled in with an osteoid bone, and where 
the peridental membrane fell over the freshly fractured dentin, 
it has built a structure, very similar to cementum, onto the 
dentin. Higher powers of these different structures are shown in 
Figure 471. in which in A there will be seen the lumen for a blood 
vessel passing through the osteoid structure, which has displaced 
the pulp tissue of the mesial root. Note the lamination of this 
osteoid structure. B shows a higher magnification of the distal 
root, and the osteoid cementum can be seen in direct apposition 
with the fractured surfaces of the dentinal tubuli. D shows a 
higher magnification of B, and C a higher magnification of A. 

It is not probable that this process can so readily obtain on 
dentin which is not potentially vital. In Volume One I have 
shown in many places, illustrations of an osteoid structure built 
into the dentin following an absorption process. It would be 
highly desirable if some such reparative process could be induced 
to develop about apical areas that have been rendered free from 
irritation products. Whether or not remote instances of this can 
be presented, it will make little difference to the clinical fact that 
the percentage of cases where it occurs is exceedingly small. 
There is, however, a structural approximation which takes place 
about excised root ends, which suggests either a very small 
amount of irritating material from the root end or, as is very fre- 
quently the case, a very low capacity for reaction to such irritant 
as does obtain in that tissue. This type of reaction is also ideal 
in periodontoclasia pockets. 

In thirty years of very critical search for illustrations of such a 
process, the instances where I have been satisfied that it had 
actually occurred to any considerable extent are few. The 
following is an illustration. The patient, a young man, Case No. 
935, was suffering from an exceptionally acute gingival inflam- 
matory process with pocket formation. As a matter of experi- 
ment I used a burr beside the palatal root of an upper molar, 
thoroughly to curette the surface of the tooth and the 
alveolar bone adjoining, to and including healthy tissue. The 
case was watched carefully and there seemed to be quite perfect 
reattachment of tissues to the root surface. The tooth was 



394 I >ENTAL INFEC 1 1« >NS4 I >EI .l.W-.H \ I l\ 1. 1 USE VSES l LINK AI. VOL. II 




Figure 171. Higher power of areas of figure 170. A snows pilling i\ of thf. pulp chamber with an 

OSTEOID BUNK THROUGH WHICH A BLOOD VESSEL WAS PASSING; B, AN OSTEOID HONE BUILT UPON THE FRACTURED SUR- 
FACE OF DENTIN, OVER WHICH I- A LAYER OF CEMENTUM; C, A HIGH POWER OF THE OSTEOID BONE OF A; AND I >. A HK.H 

POWER OF THE OSTEOID HONE OF H. 




CHAP. LXIX— OTHER TISSUES DENTIN & CEMENTUM REPAIR 395 

carried for years with but little return of the periodontoclasia 
about it or in other parts of the mouth, part of the reason for 
which was a program of prophylaxis in which the patient splen- 
didly cooperated. By a fortunate circumstance I was later able 
to secure this tooth and the attached alveolar bone. I per- 
suaded the patient that he owed it to science to make a provi- 
sion in his will so that that specimen would be preserved for 
proper study. He suggested that since the circumstances of his 
death were so uncertain I had better take it while I could control 
the conditions of its preservation and sectioning and urged that 
I do so, which I did. In cross section, the burr marks on the 
cementum could be seen and had been filled in with an osteoid 
structure so closely adapted to the tooth as to be apparently 
perfectly fused. This cementum was apparently vital at the 
time of the operation and in this particular was probably a quite 
exceptionally favorable condition. 



CHAPTER LXX. 
GENERAL DISCUSSION. 

INTRODUCTION 

In Part One, Chapters 1 to 45. I have outlined in detail a series 
of researches and presented data developed therefrom. These 
have dealt with fundamental problems underlying diagnosis, 
prognosis, and treatment of local and systemic dental infections. 
In Chapters 45 to 56, I have analyzed the various data and from 
them have made interpretations on which I have suggested a new- 
basis for dental diagnosis, prognosis, and treatment. In Part 
Two, Chapters 57 to 70, I have presented a large series of typical 
cases, illustrating the application of these principles of interpre- 
tation and methods of application, together with special re- 
searches on both the patients involved and on animals with cul- 
tures and tissues taken therefrom. These latter researches on the 
patients have thrown a flood of new light upon the whole problem 
of dental pathology when studied in the light of these new inter- 
pretations. We have seen from the experimental data that the 
strain of organism involved is a very secondary matter to the 
environment in which it is growing: namely, the host who fur- 
nishes the soil for it ; and this host is an extremely variable quan- 
tity when one individual is compared with the majority, while 
each one except under overload tends to maintain his or her own 
general characteristics. The elements of chance are almost 
entirely removed from the problem. 

The bacteria, we have found, have the remarkable ability of 
adapting themselves to changes of environment through exceed- 
ingly wide ranges so that they will ultimately grow and flourish in 
a medium that at first would entirely inhibit their growth, if not 
kill them. It is an extremely important matter that streptococci 
can so accommodate themselves to such extremely toxic sub- 
stances as formaldehyde, iodoform, phenol, alcohol, etc.. for this 
completely changes our problem of rendering a tooth so toxic to 
them that they not only cannot take up and maintain a residence 
in it at the time of its treatment but that they shall not be able to 
take up residence in it again during the rest of the lifetime of that 






CHAP. I. XX -GENERAL DISCUSSION 397 

tooth. We not only have now the problem that bacteria have 
been killed off in the tooth but that they may be able to take up 
residence in it again by becoming accustomed to an environment 
which at first was intolerable. It is for this reason that we find 
organisms growing in teeth, previously treated with iodoform, 
which still is present in sufficient quantities to be distinctly and 
even abundantly present by its odor, when they are opened years 
afterward. 

We have also seen that with varying changes of oxygen tension, 
hydrogen ion concentration, the type characteristics of the organ- 
isms may be completely changed. We find we are dealing with 
forces that are very changeable and with units of life that are the 
sum total of these changing forces in terms of their reaction to 
them. In other words, we are dealing with problems of physics, 
physical chemistry, and biology, quite as distinctly as in quanti- 
tative chemistry or pure physics. The older methods of cut and 
try with the hope and expectation that, by chance, we shall 
stumble upon some drug or chemical that is specific for the condi- 
tion at hand, gives little more hope of being the means of prog- 
nosis in the future than the past has so unhappily demonstrated 
it to be worthy of being. Nor are we justified in reading symptoms 
as evidences of either reactions or absence of reactions. It is not 
sufficient that a diabetic insists that he feels well; nor is it safe for 
the individual with a definite streptococcal susceptibility to carry 
the forces which will with mathematical certainty subtract from 
his already reduced factor of safety. The fact that he feels well 
does not prove that the corner stones of his health are not being 
slowly undermined by physiochemic processes which are drifting 
him, though unconsciously, toward a shorter life of health and 
usefulness. It is not so simple a matter as a bacterium skulking 
out of the corral about an infected tooth and taking up its resi- 
dence in the far-away heart or kidney or nerve cell. It may be 
that, fundamentally, it is primarily a breaking down of the de- 
fensive mechanism by the pouring into the system, in ever so 
small quantities at first, of substances which destroy the efficiency 
not only of the defensive mechanisms but of fundamental nutri- 
tional processes. 

It is no accident that there is a great variation in the type of 
local reaction about dental infections in different individuals. 
Nor is it a mere coincidence that different individuals of certain 
types and groups tend to have similar variations from the normal, 



398 DENTAL INFECTIONS* DEGENERATIVE DISEASES CLINICAL VOL. II 

and that there are distinct and quite exact relationships between 
the local structural changes and physical expressions of focal 
infection. We begin to see some of the forces at work in the pro- 
duction cf dental caries, of acute and chronic inflammations of 
the supporting structures of the teeth, the nature of chronic 
diseases cf the organs and tissues of the body, and the role of 
heredity. 

While there are doubtless many factors involved, regarding 
which we as yet know little, some others are becoming quite ap- 
parent. It is not an accident that, different elements which may 
be introduced, may produce the same symptoms, as, for example, 
a deficiency diet and a dental infection, such as a polyneuritis. 
Nor is it accidental or a mere coincidence that these two forces 
produce quite similar chemical changes in the bleed or that phys- 
ical overload will aggravate these very disturbances, particularly 
these which primarily disturb the very elements which are funda- 
mental to the maintaining cf the metabolic balance. Nor is it 
accidental that the same general laws obtain in the vegetable 
kingdom as in the animal. The gardner has learned to use ether 
and chloroform to put his plants to sleep, in order that he may 
hold them back without injuring their vitality, and allow his 
blccm cr fiuit to perfect on the very clay that he shall desire. Xor 
is it an accident or a mere coincidence that just as plants cannot 
grow in a soil in which the ionic calcium is net available in a defi- 
nite minimal amount and that the cells of cur body cannot main- 
tain their health except the ionic calcium of the body fluids does 
maintain a minimal balance. It is a truth that makes us stand 
aghast and more and mere appalled as we realize cur dependence 
upon the presence cr absence of these simple elements. Have we 
realized that no civilization has ever been maintained on any soil 
that did net have either a limestone foundation or a water supply 
hem such a foundation? 



CHAPTER LXXI. 
GENERAL SUMMARY. 

INTRODUCTION. 

If we would summarize the work of the preceding chapters and 
the suggestions presented, it would be somewhat as follows: 
Dental caries, deficient dental and osseous calcification, disturbed 
metabolism, and deficiency diseases are, fundamentally, expres- 
sions of a disturbed physical chemistry of the system. Some of 
the forces involved are enzymatic, some physical, and some quite 
purely chemical; and it is probable that when we have come to 
understand these, we will understand life itself, for disturbed life 
is but slightly different from the normal. This suggests, if it does 
not illustrate, how extremely involved the problems of defense 
and susceptibility are. We do not presume even to suggest what 
the final answers to these questions will be. We do find, how- 
ever, in the data from these studies, suggestions as to the probable 
course that should be taken for future explorations. From the 
information available to date I would give as the most probable 
explanation for the various phenomena herewith presented the 
following: 

Growth and health of the hard and soft tissues of the body are 
dependent upon the maintenance of definite concentrations 
among other substances of calcium in ionic form. The difference 
between the minimal and the maximal for health is small, and 
these limits are close to the optimal. Just as the range of varia- 
tion from an isotonic sodium chloride solution is very small for it 
to become hyper- or hypo-tonic to cell tissues, just so the calcium 
in ionic form must have a very exact concentration; and this does 
not mean the total quantity of calcium to be found in either the 
blood, saliva, lymph, or tissue cells, but the amount of calcium in 
such a structural form as enables it to be available as an enzyme, 
both for the interchange of other chemicals and for contributing 
directly itself to life processes. 

The total amount of calcium that is required to maintain the 
wear and tear of body function day by day is sufficiently great, 
frequently to tax the normal body when in environments where 

399 



400 DENTAL INFEC PI0NS& DEGENERATIVE DISEASES C LINICAL VOL.11 

foods are not available which have a ready supply of this element. 
Similarly, the calcium itself does not become available except in 
different ratios and proportions with phosphorus. Fundamen- 
tally, then, we are dependent upon bases of supply for these funda- 
mentals as well as many others. But even the available calcium 
in the system becomes available only because of other substances, 
particularly the endocrine system, of which probably the para- 
thyroids are the chief contributors. These endocrine glands 
doubtless are dependent upon the accessory food factors, such as 
Vitamins A, B, C, and D. The normal calcium of the blood of 
healthy individuals remains quite constant at about 10 ■ 2 milli- 
grams per hundred cc. of blood. In the normal blood in the 
blood vessels, approximately 6 ' 2 milligrams of this is always free 
in the ionic form and 4 milligrams in a combined form with nor- 
mal constituents of the blood, but 10 ' 2 milligrams go into ionic 
form in the serum when the blood is entirely clotted, the total 
calcium being the same before and after that process. Forces 
which tend to destroy this normal calcium balance, destroy a 
fundamental of the environment of the various cells and tissues, 
and, thereby, destroy one of their most important factors of de- 
fense. Yet there are many forces which tend to disturb this bal- 
ance, one of the simplest and most common of which is nutrition, 
both by the starvation of the individual for the very calcium 
itself and for those elements which, by their reaction upon the 
glands of internal secretion, establish and maintain the calcium 
metabolism. 

Another force seems equally important : namely, the toxic sub- 
stance developed by streptococcal infection, particularly in con- 
ditions of low oxygen tension and putrefactive tissue. We have 
shown that by the injection of this substance, bacteria-free, into 
animals, the ionic calcium has been immediately lowered and the 
pathologically combined calcium directly increased; also that the 
long continued tying up of part of the available calcium of the 
body fluids brings about chronic or diseased states; that these 
diseased states develop in the organs and tissues whose defense 
has been lowered either by trauma, starvation, physical or mental 
overload, or by heredity; and in case there has been no physical 
force to determine what tissue will break first, very often, if not 
generally, heredity answers the question; and hence we have in 
one family the kidney breaking first, in another the heart, in 
another the joints, etc.; and we call it "Heart disease running in 



CHAP. I. XXI GENERAL SUMMARY 401 

the family." And if to the toxic neutralization of partly available 
calcium, we shall add an excessive or undue overload of demand 
for calcium, such as pregnancy, we have enormously aggravated 
the pathological state; and if, perchance, the individual is not 
taking enough calcium to maintain even a normal calcium bal- 
ance, let alone supply a large and new demand for the growing 
fetus, it then develops to be more than an embarrassment but 
a real tragedy to the system, for the neutralized calcium of the 
toxic element reduces the available to far below the minimum 
that is possible for the maintenance of health, and the defense is 
broken. A physiological strain becomes a pathological lesion. 

Before we can know the full answer to this difficult problem of 
the role of calcium there are several additional things we must 
know, among them the following : 

To what extent is the disturbed ionic calcium a primary condi- 
tion, and to what a secondary expression or symptom? I have 
shown in the various experimental chapters that the same gross 
clinical symptom may be present in two different individuals and 
one of them have an abnormally high ionic calcium and the other 
have an abnormally low ionic calcium. For example, of all the 
cases that present to me for study of their rheumatism, probably 
nine out of ten have a low ionic calcium and one in ten an abnor- 
mally high ionic calcium. This proportion is not based on analy- 
sis of data and is only relatively correct, but for our purpose an- 
swers for an illustration. The symptoms, as presented by the 
patient, would under casual observation seem to be similar. Yet 
these groups represent two entirely different pathological states. 
The group with the low ionic calcium tends to have a proliferative 
type of arthritis; the other tends to have a degenerative type. 
Similarly, of the various patients presenting with pathological 
changes resulting from reactions from irritants and infections 
about teeth, some will have very marked diminution of bone, 
again a degenerative type of reaction, and others will have a 
marked condensation of bone, corresponding with the prolifera- 
tive type ; and in these two types the ionic calcium of the blood is 
low in the group with the proliferative calcification reaction, and 
is high in the group with the degenerative type of reaction. We, 
therefore, see that we have comparable conditions in these two 
pathological states, which we have used to illustrate divergen- 
cies, or what might be taken to be anomalies. They are not 
anomalies but are evidence of disturbance of entirelv different 



402 DENTAL INFECTIONS & DEGENERATIVE DISEASES C LINK AI. VOL.11 

types of disturbances in calcium metabolism and general tissue 
reaction. It is evident, therefore, that it is not so simple a matter 
as the mere presence or absence of ionic calcium of the blood, but 
it has to do with factors which relate to fundamental processes in 
which calcium is a factor but only one of several. 

I have shown that several other factors are variable quite 
parallel to that of the variation in ionic calcium. One of these is 
the alkalinity index and another the bactericidal property of the 
blood and leucocytes. If the maintenance of the alkali reserve of 
the blood or any fluids or tissues of the body comes to be depen- 
dent upon the utilization of calcium, the symptoms will be en- 
tirely different, as in practice we find them to be, from those which 
obtain if this abnormal demand does not exist. Hence in perio- 
dontoclasia we have a very extensive wastage of organized calci- 
fied tissue to maintain a large factor of defense as alkalinity of the 
bathing fluids. The cost of the maintenance of the defense of the 
host is paid for in calcium currency which is taken from alveolar 
bone. We do not know what all these abnormal demands are, 
but some of them seem clearly to be the neutralization of imper- 
fectly oxidized acids which are not reduced to carbon dioxide and 
eliminated as gas, but are neutralized in the blood stream and 
tissues by calcium in the absence of cheaper bases. A perfect 
combustion will reduce all of the food taken into the blood to 
carbonic acid gas, urea, and water. Intermediate acids will, 
therefore, have to be neutralized and will be excreted largely 
through the kidneys where they may be identified. The mechan- 
isms, by which the alkali reserve is maintained in the body, have 
not been disclosed. There is a strong suggestion, however, that 
the parathyroids play an important part in this mechanism as well 
as in the neutralization of the toxic products of bacterial invasion. 
\\ e do not yet have tests to determine the efficiency of para- 
thyroid function. The clinical data that I have herewith pre- 
sented, however, seems abundantly to demonstrate that in many 
individuals the administration of small quantities of parathyroid 
for a few days greatly assists in reestablishing a broken defense. 

But these researches have thrown a very important new light 
on the nature of these pathological lesions which result as a 
systemic expression of a focal infection. They have demon- 
strated not only that various forces, such as heredity and over- 
lead, predispose and that the predisposition carries with it tissue 
specialization for localization, but also strongly suggest, if they 



CHAP. LXXI GENERAL SUMMARY 403 

do not demonstrate, that after the bactericidins of the leucocytes 
are exhausted, defense itself for streptococcal infections is under 
certain conditions almost exclusively a local quality of the various 
fluids, tissues, and organs of the body ; in other words, individual 
cells in the various organs and tissues make the fundamental 
last stage warfare against streptococcal infection in strong con- 
trast, for example, with the antitoxin that is developed by the 
body for the general circulation as a defense against the toxin 
produced by the Loftier bacillus which produces diphtheria. 
There have been many clinical conditions to suggest that this 
was true before it was demonstrated, as, for example, organisms 
of the streptococcal group, which are biologically similar, produce 
a very wide range of systemic involvements, almost as wide as 
the assortment of organs and tissues of the body ; and also by the 
local tissue reactions to stimulation, such as heat, massage, etc. 
We have, therefore, two factors which are paramount, if not the 
most important, in this combat between the organism and the 
host: First, the almost unlimited power of adaptability on the part 
of the type of organism which develops in dental infections; and, 
second, the reacting capacity of the various tissues of the body. 
One of our greatest difficulties in combating focal infections will 
therefore be the raising of the defensive mechanisms of local tissue 
cells in a host in whom they are by inheritance or acquirement 
depressed or absent. We see very little hope for changing the 
biologic characteristic of this organism to deprive it of its mar- 
velous ability for adaptation. The two most hopeful methods 
are by more efficient vaccines and by the development of synthet- 
ic bactericidins. 



CHAPTER LXXII. 

GENERAL CONCLUSIONS. 

INTRODUCE ION 

It is too early, because the information available is too limited, 
to make more than general conclusions, and these should be con- 
sidered tentative- until further data shall be available from as 
large a number of sources as possible. 

Conclusions. 

1. Dental infections are not local, oral problems. 

2. Dental caries is primarily a local expression of a 
systemic condition in combination with abnormal 
local physical conditions. 

3. Periodontal infections with periodontoclasia 
(pyorrhea, Riggs 1 diseases in the primary stages are 
fundamentally the expressions of a vigorous reac- 
tion to local irritation, combined with a systemic 
exaltation of the defensive mechanisms. 

4. Calcium metabolism disturbances are funda- 
mental factors in both dental caries and periodontal 
diseases, though dissimilar disturbances. 

5. The absence or presence of susceptibility to 
systemic involvement from dental infections is fun- 
damentally an inherent quality inherited as other 
unit characters are, or a matter of broken defense 
due to overload, or a combination of both. 

6. Inherited susceptibility, or Mendelism, as ap- 
plied to susceptibility of various organs and tissues, 
is a unit quality pertaining to individual organs and 
tissues independently of other organs and tissues. 

7. Dental infections are fundamentally chiefly 
an expression of the biologic qualities of the host or 
culture medium rather than of the invading strain 
or organism. 

S. The phenomena of tissue reaction is in many 
instances a true allergic reaction of antibody and 
antigen. 

( ). The so-called rheumatic group disturbances 
are in part symptoms of systemic sensitizations, an 
important factor in which is an inherited or an ac- 
quired calcium metabolism disturbance. 

101 









CHAP. LXXI1 GENERAL CONCLUSIONS 405 

10. Calcium disturbances are themselves second- 
ary to the acid-base and toxin neutralization gov- 
erning mechanisms, one of which is parathyroid 
functioning. 

These suggest as imperative, exhaustive re- 
searches on the following problems: 

1. The fundamental factors involved in calcium 
metabolism. 

2. The role of calcium and its physicochemic re- 
lations to dental caries. 

3. The mechanisms of sensitizations of various 
types. 

4. Determination of Nature's chief defensive fac- 
tors for the neutralization of toxins. 

5. Determination of the nature of the toxins de- 
veloped in both apical and gingival infections. 

6. The role of oral toxins in the development of 
tissue sensitizations. 

7. Artificial substitutes for natural defense. 
These will require hundreds of skilled workers 

with every convenience and assistance that can 
add to their efficiency, which will be discussed in 
the following chapter. 



CHAPTER LXXIII. 
RESEARCH INSTITUTES FOR DENTAL DISEASES. 

Some great new biological facts have come to the knowledge of 
the best students of public health, which establish the conviction 
that a great many of the affections which we have looked upon as 
diseases are only symptoms (of which there are many), of a gen- 
eral systemic invasion by a strain of organisms residing protected 
in special tissues and against which the body is not capable of 
making a successful warfare which can culminate in their com- 
plete elimination. A distinguished scientist and world surgeon, 
stated in substance in my hearing recently that of the several 
hundred people in his audience it was his belief that, when they 
died, the final blow would be struck in nine out of ten cases by an 
organism which they would be carrying, at the time, as an ap- 
parently harmless invader so long as their resistance was high, 
but that it would wait its chance, and when their resistance was 
lowered sufficiently from any cause, it would strike and strike 
hard, perhaps not suddenly. He stated that he was figuring that 
the other ten per cent would die by accident. 

What he was saying is the thing that we are seeing in various 
ways and do not recognize. For example, we do not realize, until 
we study the statistics, that in one in ten of all the funerals that 
go by, a life has gone out by premature failing of the heart, due to 
its being diseased. A very large number, though not quite so 
large, dies from kidney involvement; another large group from 
nervous system or lung complications produced by this same 
organism. It is estimated that more than ninety per cent of the 
heart involvements are produced by germs of the streptococcus 
group (diplo-streptococcus) which also produce nearly all of the 
rheumatic group lesions, including many of the kidney lesions 
and many of the fatal complications of nervous breakdown and 
pneumonia, also rheumatism, neuritis, appendicitis, gall-stones, 
etc. This is the germ that in more than ninety-nine per cent of 
cases is found in infected teeth, though other organisms may often 
accompany it ; and it is the one, and usually the only one. found 

106 



CHAP. I.XXIII DENTAL RESEARCH INSTITUTES 407 

in the lesions developed in animals by inoculating them with in- 
fections taken from the teeth. It is also estimated that in about 
ninety per cent of cases of streptococcal infection, it finds its en- 
trance into the body from the teeth or tonsils; and of this ninety 
per cent, before six years of age, the tonsils play the most impor- 
tant part, but after six and eight years of age the teeth are the 
portal of entry in by far the largest proportion of cases. 

Applying this, then, to the premature funerals that we see going 
to the cemetery from heart infection, the data available at this 
time seem clearly to establish that the teeth are by far the most 
important contributing factor. In other words, the available 
evidence today indicates that the average span of human life is 
shortened by years, because of the direct and indirect effects of 
dental disease; or stating it otherwise, if there were no dental 
diseases, the normal span of life for individuals in civilized com- 
munities would be many years more, than at present. 

We have not said anything about the great scourges which 
make life less to be desired than death, such as acute inflamma- 
tory rheumatism and deforming arthritis which so often make their 
victims steadily turn into castings, bound in every joint, suffering 
in many and sometimes apparently in every nerve, and chained to 
a rack of torture, unable to feed themselves or do themselves 
either good or harm. Of this affection, Sir William Wilcox 6 has 
stated in a recent issue of a British Medical Journal (Jan. 13, 
1923) that he agrees with Dr. Beddard that over ninety per cent 
of the cases of non-specific infective arthritis are due to infection 
arising from the teeth. 

The progress of the past twenty-five years has brought about 
simply an awakening of a danger, but the great public is nearly as 
helpless as it has been in the presence of any of the plagues during 
the past centuries. Its members do not know where their danger 
is nor how to prevent it ; nor can their guides, the members of the 
dental and medical professions, tell them, for the information is 
not available. So far as humanity is concerned, there are prac- 
tically as many cases of periodontoclasia today as there ever were. 
This disease takes, as its toll, more teeth than most, if not all 
other dental diseases combined. It is not at all probable that one 
in a hundred of the citizens of the United States has either the 
information or the equipment to keep that disease under control; 
nor is it probable that one per cent of the dental profession could 
furnish the information and equipment adequate for so doing, 

■6 See bibliography 



408 DENTAL INFEC I [ONS& DEGENERATIVE DISEASES C LINICAL VOL. II 

certainly not five per cent. There is, today, as much or more 
dental decay, and statistics seem to indicate very much more, 
than ever before in the history of the world. This can be judged 
by the indelible records written in the skeletons for of all the 
tissues of the body the teeth last the longest and the cavity of 
decay will be present relatively unchanged, regardless of the age 
of the skeleton. 

And why is it that with the efficiency of modern social organi- 
zation and the greatly advertised dental science that all this has 
not been, and cannot be corrected in a few months or years at the 
most? First, because the universally accepted fundamentals of 
dental diseases and their symptoms are based on fundamental 
misconceptions or half truths; and second, because the amount of 
effort that is being made is so small, when compared to the enor- 
mity of the task, that it will take many generations before human- 
ity, even in far advanced and cultured communities, can be saved 
as a mass. The present generation of dentists cannot solve this 
question for they have neither the fundamental education to 
make them capable (and many have not even the disposition to 
acquire it) nor the facilities with which to correct their misinfor- 
mation and establish the facts. Dental diseases are so related to 
the special dental anatomy, physiology, and pathology that these 
problems must be solved by individuals with special training 
in both of these broad fields. Neither the medical profession 
alone nor the dental profession alone can solve them. There is 
little more general knowledge about the causes of dental decay 
and the causes of periodontoclasia today than twenty-five years 
ago, and very little more then than twenty-five years before that. 
In other words, during the thirty years that I have been in active 
dental research, not five per cent of the necessary new informa- 
tion has been acquired. I recently asked a distinguished dental 
educator how long he thought it would take before the dental col- 
leges would be teaching an adequate and safe program of pre- 
vention, and his estimate was forty years. The medical profession 
has been trying for fifty years to solve the problems of dental de- 
cay and mouth infections and has made exceedingly little prog- 
ress. This work must be done by men with a very broad training 
in the minute clinical and structural pathology of dental disease 
as well as of general medicine and the biological sciences. It will 
take several centuries to accomplish the solution of these problems 
at the rate we are going under the present arrangement of having 



CHAP. I. XXIII -DENTAL RESEARCH INSTITUTES 409 

the research work done at night by men who are exhausted from 
the efforts of the day to earn the bread and butter for themselves 
and their families, either in dental practice or in preparing lec- 
tures and teaching dental and medical students. This work must 
be done in institutions in which every function and detail is 
adapted to the fundamental requisite of research on dental 
diseases. 

This has been a physical impossibility in the past because there 
have been no institutions in which these great problems could be 
adequately studied. For example, it is estimated that there are 
funds available today for general medical research, as endow- 
ment, aside from equipped laboratories, amounting to over 
$250,000,000; while there is not $1,000,000 available as endow- 
ment, according to recent evidence, for research on dental dis- 
eases, which is a problem that is second to none in all the interests 
of humanity. 

It is because of a realization of these important facts that I 
have so earnestly endeavored to create a spirit of research and to 
organize an adequately endowed institution and by assisting in so 
far as I can in organizing its work on an efficient and permanent 
basis, and start a new order of progress which will go forward 
with as much dispatch as possible. I have no doubt that in my 
dental practice, single-handedly, I have added several hundreds 
of years to the sum total of the efficient and comfortable life of 
my patients, and I am only one of forty thousand practicing 
dentists. I am very sure that my efficiency is far short of what it 
can be and will be for the coming, better informed, efficient mem- 
bers of the dental profession. 

Hence, who can estimate the value in years that may be added 
to the comfort and life of the individuals of the nation in coming 
generations? Nor is this all. Much of the dentistry of today 
not only is not intelligently removing from individuals those 
sources of available infection which the undisturbed decay and 
gingival infection have produced, but many of the operations of 
the so much heralded American Dental Science are establishing 
and retaining the very conditions, which if Nature were undis- 
turbed she would more readily throw off, for in spite of the 
splendid service of the majority, modern dentistry frequently 
takes infected roots and with elaborate structures anchors them 
solidly to other teeth. In this way incalculable harm may be 
done by some of the legally practicing members of the dental 



410 DENTAL INFIX TIONS& DECiKNKRATIVEDIS] VSES CLINICAL VOL.11 

profession. For some of these it is gross ignorance; for some, we 
are sorry to say, it is indifference plus ambition to make money 
as fast and as easily as possible. My observation is that a con- 
siderable number of the members of the dental profession of 
today do not want to hear the message that condemns the teeth 
upon which they desire to make operations. It is necessary for 
this and for other reasons, including politics and jealousies and 
institutional ambitions and pride, that for the greatest efficiency 
the institutions that will do the most fearless and aggressive dental 
research will be independent to function in every way that will best 
accomplish the attainment of new truth. 

They should have as a minimum an available annual income for 
prosecuting their researchesof not less than $50,000, and preferably 
much more than that amount. The former would be equivalent 
to an endowment of $1,000,000 at five per cent. Buildings ade- 
quate for housing the work in an efficient manner that would be 
represented by an annual budget of $50,000 would probably cost 
$150,000 or more, if built, especially for the work of brick or 
stone. This would not include equipment which would cost 
approximately $50,000. 

In addition to developing the new truths which underlie both 
correct living and adequately improved medical and dental 
methods of practice, there must be developed a new type of prac- 
titioner. He will be neither a physician nor a dentist, nor both 
in the sense that he will be a combination of the two as they 
exist today. The science and art involved in the interpretation 
of the profoundly obscure and involved relationships, which may 
exist between the local and the systemic expressions of dental 
disease, can only be provided by men who have had a special 
training, quite unlike that that can be furnished by any dental 
or medical schools of today. 

These researches, which I have recorded in this book, illustrate 
splendidly how neither the medical nor the dental profession has 
been able with its training and equipment of the past to diag- 
nose, prognose, and treat these most intricately involved patho- 
logical interrelationships; and while we have arrived at the point 
where we can see the necessity for this new type of practitioner, 
we could not develop him today in any institution, available for 
teaching, that now exists. There must be developed both a new 
foundation of combined special medical and dental science and 
new methods of application. 



CHAP. I. XXIII DENTAL RESEARCH INSTITUTES 411 

The progress that has been made in the researches reported in 
this volume has been accomplished, largely, by changing the 
method of approach to this whole problem. In the past, effort 
has been made, mostly, to solve fundamental problems, etc., by 
either one of two chief methods, namely, the clinical or the 
laboratory point of attack. If I have made progress, it is because 
I have combined the two methods in one institution. Neither 
can ever accomplish it alone. 

Efficient research institutes for dental disease must have, 
exceedingly good clinics which will not only provide a great 
variety of types of associated local and systemic dental pathol- 
ogy, but a sufficiently large number of the different groups which 
may be considered comparable, to make possible the tabulation 
of data and thereby enable the research workers to trace the symp- 
toms through the maze of confusions to their source ; and these 
institutions must be so well equipped with trained scientists and 
the newest apparatus that it will be possible to apply all the 
available newer methods to these studies. Nor will it be sufficient 
to have great clinics and equipped laboratories manned by 
skilled scientists. They must have, and this is the most difficult of 
all to find, directing minds and hands whose vision is as far in 
advance of the teachings of the profession as it is possible to ob- 
tain. These men are rare and they can only be interested by fur- 
nishing an environment and equipment that supplies as nearly 
ideal working conditions as possible for a life devoted to scien- 
tific research. Such an atmosphere will not only attract men 
already possessing a well developed vision, but it will create such 
a vision in its developing staff. 

Probably the greatest source of wastage in all world progress is 
the lack of understudies. Men climb through weary hours of 
almost endless struggle over the foothills to the watershed range, 
and just as they get to a point of vantage, where they can see 
somewhat of the probable course of the stream they are seeking 
to explore, they fall exhausted and a new explorer must start 
again at the foothills. We must keep pushing our advanced 
bases continually so that as little as possible of the ground that is 
gained will be lost, for the lifetime of any worker, at best, is short. 
Probably no worker in the field of dental bacteriology has ever 
climbed so high on the watershed as Professor Miller twenty-five 
years ago; nor has anyone arrived again at the milestone reached 
by Michaels in sialology twenty-three years ago. Therefore, the 



412 DENTAL INFE< riONS& DEGENERATIVE DISEASES CLINICAL VOL.11 

competent research institutes for dental diseases would be or- 
ganized not only to develop men for their own enlarging staffs, 
but men for going cut to other institutions to build up similar 
work and, particularly, to man the dental colleges. 

The most important change that must come in all the applica- 
tions of dental science is in the viewpoint. Dentistry was born 
as a mechanical art. The whole attitude of medicine has been to 
treat it as such and the attitude of the dental profession, until 
recent years, has been to recognize it only as such. Before any 
dental operation whatever can be given even preliminary con- 
sideration, the problem of the tissue involved must be considered 
frcm the standpoint of human economy ; and in that problem, the 
future as well as the immediate present must be considered. In 
the future it will not be: What mechanical art is dental science 
able to apply to a given broken or disfigured tooth? but, first of 
all, What is the relation of that affected member to the health 
and efficiency, as well as the comfort and appearance, of the 
individual? The dentistry of the future must be fundamentally 
based upon a foundation of pathology rather than of mechanical 
skill and art. No less art and skill will be needed in the legitimate 
restorations, but the operation of choice will not be decided on 
mechanical bases. Therefore, the dental colleges of tomorrow 
must have as their controlling motive, health and efficiency ; and 
every motive, policy, and purpose, will first be decided on the 
basis of pathology ; and I will make a prophecy that every dental 
school in the land will go out of business that is not organized 
upon that basis. 

Accordingly, adequately organized research institutes for 
dental diseases will provide for very advanced postgraduate 
work on the fundamental knowledge of the relation of oral infec- 
tions to systemic disease and the most advanced means for their 
application, since every operating dentist, no matter what his 
specialty, must be, primarily, a dental diagnostician unless he be 
so fortunate as to be associated with a group, some member of 
which is skilled in that important branch and is able to suggest 
the course that should be pursued. It follows, therefore, that the 
organization of adequate institutions for most advaneed investiga- 
tion and most helpful professional assistance will hare the following: 
(1) An ample endowment to make possible both 
a large and a permanent work; 

2 Adequate buildings, well lighted and well 



CHAP. LXXIII DKNTAL RESEARCH INSTITUTES 413 

located; 

(3) Most up-to-date scientific equipment; 

(4) A director with an appreciation of the problem 
from the standpoint of the patient, the healing pro- 
fessions, and the development of their sciences, the 
most advanced methods for scientific research, the 
needs of the scientist for his most efficient service, 
the skill in the organization of the clinic, the needs 
of teaching institutions, and familiar with methods 
of publication; 

(5) A staff of skilled scientists, trained in the ap- 
plication of various branches of biological science; 
and 

(6) Last, because it is first, a board of trustees with 
a love for humanity, which makes possible the con- 
summation of this great work, and in whose hearts 
must come a joy that is known only by the world's 
greatest benefactors and is that one quality which 
makes man a superman because he becomes a co- 
worker with his Creator. 



BIBLIOGRAPHY 

1. Dublin, Louis I.: Incidence of heart disease in community. Na- 

tion's Health 4:453-456, Aug. '22. 

2. Maver, M. E., and Wells, H. G.: Biochemistry and chemotherapy 

of tuberculosis; chemical composition of calcified tuberculous 
lesions. Am. Rev. Tuberc. 6:649-658, Oct. '22. 

2. Olitsky, P. K., and Gates, F. L. : Methods for isolation of filter- 
passing anaerobic organisms from human nasopharyngeal secre- 
tions. J.A.M.A. 78-1020-1022, April 8, '22. 

4. Goadby, K. W. : Diagnosis of latent infection about the jaws. 

J.N.D.A. Part I, May, 1922, p. 371; Part II, June 1922, p. 504. 
Streptococcal infections arising from mouth. J. State Med. 30:415- 

423, Oct. '22. 
Importance of industrial medicine to community. Brit. M. J. 

2:317, Aug. 27, '21. 

5. Banting, Best, Collip, Hepburn, and Macleod: Trans. Roy. Soc, 

Canada 1922, Vol. 16, Sec. 5, p. 35. 

6. Wilcox, Sir William: British Medical Journal, Jan. 13, 1923. 

7. Pearl, Raymond: From Proceedings of National Academy of 

Sciences, Dec. 1919, Vol. 5, No. 12. 

8. Libman, E.: Characterization of various forms of endocarditis. 

J. A. M. A., Vol. 80, No. 12. 

9. Rosenow, E. C. : Mouth infection as a source of systemic disease. 

A. M. A. Jnl., LXIII, 1914. 2027. Disc. 2029-2032. Summary, 

XXXV, 1915, 4-6. 
Elective localization of the streptococcus from a case of pulpitis, 

dental neuritis and myositis. Ortho. Int. Jnl. II, 1916, 713-725, 

16 illus., 1 table. Cosmos, LIX, 1917, 561-562. Abstract. 
The relation of dental infection to systemic disease. Allied XII, 

1917, 400. Abstract. Cosmos, LIX, 1917; 485-491, 2 tables. 

Pacific D. Gaz., XXV, 1917, 612-620, 2 tables. Selected. Register, 

LXXI, 1917, 286-289. Abstract. 
The pathogenesis of focal infection. Cosmos, LX, 1918, 303. 

Abstract. N. D. A. Jnl., V, 1918, 113-124, 6 illus. 
Focal infection with special reference to oral sepsis. Minneapolis 

Dist. D. Jnl., II, Dec, 1919-20, 3-5. 
Studies on elective localization: Focal infection with special refer- 
ence to oral sepsis. N. D. A. Jnl., VI, 1919, 983-1023, 46 illus. 

Disc. 1024-1029. Portrait, 982. Research Jnl., I, 1919, 205-267, 

1 illus., 2 tables, 9 plates. Disc. pp. lxxii-lxxxi, 6 illus. Comment, 

519-522. 
Elective localization and focal infection from oral sepsis. Register, 

LXXIII, 1919, 557-567. Abstracts. Brit. D. Jnl., XLI, 1920, 

223-224. Abstract. 

415 






BIBLIOGRAPHY— CONCLUDED 416 

Elective localization of bacteria following various methods of inocu- 
lation, and production of nephritis by devitalization and infection 
of teeth in dogs. J. Lab. & Clin. Med. 7:707-722, Sept. '22. 

and Meisser, J. G. : Nephritis and urinary calculi after production of 
chronic foci of infection, preliminary report. J. A. M. A. 78:266- 
2(57, Jan. 28, '22. 

10. Billings, Frank: Focal Infection. New York: D. Appleton & Co., 

1917, 1918. 
Mouth infection as a source of systemic disease. Pacific D. Gaz., 
XXV, 1917, 261-262. Selected.' 

11. Hunter, W. : Coming of age of oral sepsis. Brit. M. J. 1 :859, June 

11, '21. 

Oral sepsis as a cause of disease. London, Paris, N. Y. and Mel- 
bourne: Cassel & Co., Ltd. 1911. 

The role of sepsis and antisepsis in medicine and the importance of 
oral sepsis as its chief cause. Register, LXV, 1911, 579-596. 
Abstract. 

Oral sepsis in relationship to "Septic Anemia." Brit. D. Jnl., XXXV. 

1914, 161. Disc. 161-163. Record, XXXIX'. 1911, 144. Disc. 
144-146. Selected. 

12. Mayo, Charles H. : Mouth infection as a source of svstemic disease. 

A. M. A. Jnl., LXIII, 1914, 2025-2026. Disc. 2029-2032. Amer. 
D. Jnl., XII, 1914-15, 407-412, 2 illus. Brit. D. Jnl., XXXVI, 

1915, 122-124. Selected. Digest, XXL 1915, 195-196. Selected. 
Ortho. Int. Jnl., I, 1915, 35-38. Abstract. Summary, XXXY. 
1915, 1-4. 

The relation of mouth conditions to general health (re care of school 
children). N. D. A. Jnl., VI, 1919, 505-512. 

13. Wells, H. G., DeWitt, L. M., and Long, E. R.: The chemistry of 

tuberculosis. Williams & Wilkins Co., Baltimore, U. S. A. 1923. 

14. Farrand. Livingston: Science review on "The Nation and its 

health." January, 1923. 



COMBINED INDEX FOR VOLUMES I and II 



Abscess— See Lung 

Absorption 

apical, as related to danger 

extent of area not a measure 

related to high resistance .... 

apparent or actual, not danger in a given infection 
as an expression of dental infection in bone 
at root apex should not determine diagnosis 
extensive ....... 

gingival and apical, as related to systemic defense 
hidden by other structures .... 

of bone ' . . 41,68,71, 

of roots 



il'.V.I-. 



periapical 

relative to extent 

tooth . 

visible, and tooth infection 

absence of, even in presence of infection 

may have other causes 
Acid 

and alkali balance of blood ..... 

—base of blood as related to symptoms and treatment 

— base relationships in blood ..... 

bases for neutralizing 

calcium base for neutralizing 

in dental caries 

producing bacterium in caries 

uric, in blood 



68, 109, 121, 167, 630, 28 

630, 28 

630, 28 

. 176 

89 

. 121 

68, *69, *84, 132 

. 601 

627, 25 

79, 112, 124, *577 

45, 112, *489 

51, 77, 119, 126 

167, 627, 25 

. *42. *388 

121, *123, 629, 27 

*39, 122, 629, 27 

629, 27 



. 542 

. *558 

. 262 

. 540, 402 

540, *544, *547, 402 

. 361 

133, 154, 636, 35 

. 261 



Acid-Alkali Balance and Calcium 
dental infections disturb their relationship 

Acid-Base Balance .... 
and susceptibility to tuberculosis 

Acid-Base Factors .... 



. 641 

540, 546, 547, 641 

. 363 

121 

555, *557, *561, 405 



546, 555, 633, 103, *106, 122, 229, 245, 31 



55, *57, 396, 403 
. 266 

. 426 



Acidosis 

Adaptability 
streptococcal 

Adhesions 

Adrenalin 
produces serious effect on patients with hyperglycemia 

Age 
as a contributing overload which modifies defensive factors 265, 633, 31 
as related to root-filled teeth and infection ... 44 

heart disease increases with ...... 265, 51 

over 90 per cent of individuals forty-five years of age and over have 
dental infection . . . . .51 

""Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 

417 



418 



( OMBINED INDEX FOR VOLUMES I AND II 



Albumins 



\'M,l: 

241, 132 



Alcohol 

as an overload to dental infections . . 282 

used to determine ability of streptococci to adapt themselves to 
environment ......... 61 



Alimentary Tract and Associated Organs 

Alkali -See Acid 

and acid balance of blood 
of saliva in dental caries 



285. *295, 318, 246 

. 542 
. 359 



reserve 

and ionic calcium related to gingival infections 241, 636, 34 

depression . . *242, *259, 540, 555, *558, *561, 103 

of blood .... 633, 31 

of blood and saliva, in etiology of periodontoclasia . 354 



Alkalinity Index . 
and the relation of calcium to 
of blood 
relation of, to calcium 

Allergic Reaction 

Alveolar 
bone, a cross section of . 
bone, streptococcal infection in 
destruction about infected roots 



241, 540, 555. 107. 245, 402 

. *547 

*557 

*544, *561 

364, *371, 404 



. *473 

109, 113, 226 

. 112 



Ameba 

deep in gingival tissue in region of periodontoclasia . . *412, *413 

from abscess, which probably was caused by dental infection . *410 

An Interpretation of Radiation Reactions .... 592 



4C9, 



*410, *411 
638, 36 
638, 36 
638, 36 



364. *371. 636, 35 



Ameba and Spirochete Infections . 
may pass to other tissues 
may produce systemic involvements 
not usual ...... 

Anaphylactic Reactions 
produced by sensitization reactions . 

Anaphylaxis— See also Sensitization 

from dental infections .... 611 

produced in animals by injection of toxic substance from teeth 373, 596 

Anatomical 
complications in roentgenograms 
diagnosis, toxemia as cause of death 

Anatomy 
of the aorta, microscopic 

Ancestrm. Involvement .... 

Anemia 

secondary .... 

Anesthesi \ 

infiltration of, depends on supporting structure^ 
infiltrative in various groups of varying conditions 
inspired mouth infection in 

maxillary 

'Illustration <>r chart 

iIMam face figures, Vol. I. bold face, Vol. II. 



48, 


130 
63 




61 


90, *93 


, 48 


211 


73 
, 79 


175, 


608 

87 

128 

126 







fPAGE 


. 


, 93 








71 






71, 


*72 






71, 


*72 






71, 


*72 






l - IMBINKI) INDEX FOR VOI.IMKS I AND II 119 



Angina Pectoris . 
dental infection involved in 
heart involvement from 
kidney involvement from 
tooth implantation from case of 

Animal — See also Implantations, Guinea-Pigs, Rats 

best suited for sensitization tests . ... 374 

defense, determination of (study of blood chemistry and physical 
expressions of leucocytes) ....... 504 

experimentations, with dental infections, effect on ionic calcium 
of blood .607 

inoculation, with various dental cultures and toxic substance from 
teeth, gain and loss of weight ...... *404 

passage 

coccus only organism found in root canal infection . 66 

destroys organisms except diplococcus ..... 56 
makes infections more virulent ...... 457 

reactions and patients' symptoms ...... *288 

Ankylosis 

relieved *199, *200 

typical illustration ........ *499 

Anterior Poliomyelitis ... ... *273, 95 

Antrum 
continuation of pyorrhea pocket to . . . . . .41 

empyema of ......... . 261 

Aorta 

microscopic anatomy of ....... 61 

Aortic Arch Lesion *297 

Apical Reactions and Periodontoclasia 

direct relationship between .... 150, 158, 167, 630, 28 

Apical Resorption 

as related to danger 121, 167, 630, 28 

extent of area not a measure ...... 630, 28 

related to high resistance ...... 630, 28 

Apices 
of roots 

different types of reaction involving ..... 69 
organism found when infected ...... 66 

Apicoectomy . . 387 

when it is a favorable operation for certain individuals . .179 

Appendicitis 

acute . . .... 85, 252, *255, 261, 264 

reproduced in rabbits ..... 264, *265, 267 

frequent attacks following dental operations .... 257 

Appendix 246 

Arsenic 

being used by dentists for devitalization of dental pulps? . . 131 
causing necrosis in dog's mouth (supporting structures) . .129 
tends to be specific for treponema pallidum .... 329 

""Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



•120 c < imbined index for volumes i and ii 

Arthritic 

changes in external surfaces of tooth with calcified pulp *495 

cripples and pregnane v overload 265, *153 

involvement of dental attachments 470, 480, *489, 128 

Ak i hritis — See also Rheumatism 116, *234, '292 

and education 149 

and heredity 193, *194. 195 

and inherited susceptibility 150 

and ionic calcium 192 

and joint infection *173 

arthritic knee . *Frontispiece B 

Deforming *65, *174, *176, *177, 180, *181, *194, *198, 226. 264. 407 

and heart involvement 96 

and streptococcal pneumonia 128 

and susceptibility chart * 182, 183 

bedridden . . .175 

of dental infection origin 407 

Degenerative . *94, 185, *193, 225, 287, 296, *298, 401 

in patients 

causing dental involvements 486, 500 

Deforming *185, 486 

teeth from patient with . . *74, 487 

Proliferative 73 

in pregnancy 146, *148, 149. 192 

in rabbits 

Degenerative . 70, *478, *479, 484 



Proliferative 
Purulent 

typical deforming 
involving teeth 



70, 73, *334, *476, *480 
37, 38 
63, *64, *184, *197 
128 
multiple, may attack attaching membranes of teeth . 639. 38 

normal knee ... . . *Frontispiece A 

of the spine ... . *179, 236, *237, 238, *239 

Proliferative ... 296. 401 

Purulent *67, *178, 231, *232, *233, *234. 296 

pulps of arthritic patients tend to become involved 640, 38 

Suppurative . .... . *373 

Aspiration 

from apical area showing giant cells 112 

from dental fistulae to study contents 178 

of infection .... .126 

to compare blood count with patient's circulation 47 

to establish location of cyst 45 

Asthma ... .132 

and dental infection 133 

may be produced by sensitization reactions 364. 636, 35 

\tk'( hi iv See also Marasmus 
of muscle 401, *403. 95. 280. 2S1 

tissue, in rabbit after injection of dental culture . *402 

AUTOGENOUS— See Vaccine- 
vaccines 82, 96. 175 
Axillary Gland Involvement *67 

Bach LUS 

found after culture injected from original focus 56 

'Illustration oi chart 

I'Plain face figures, Vol. I; bold face, Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 



421 



Bacteremia 
means for diagnosing 
of dental origin 
streptococcal 



hPAGE 

ION. 344 
62 
62 

*63, 343 



Bacteria — See also Organisms, Strains 

fortress for, environment produced by infected pulpless 

teeth 215, *223, 634, 32 

in a large proportion destroyed by granuloma . *468 

acid producing, in caries ..... 358, 636, 35 

rarely shut out by root canal fillings . . 199, 229, 631,29 

Bacterial 

examination after medicaments are placed in root canals 190 

examination of pulps of teeth with caries and no exposure 138 

flora in periodontoclasia ....... 346 

invasion 

and pus affected by radiation . 336, 635, 34 

causing elective localization ...... 286 

in dental infection ..... 67 

property which determines localization ..... 303 

Bactericidal 
content of blood, decreased, susceptibility to 501, *516, 526, 82 

power of blood . . . . *531, *537 

properties of individuals, marked difference . . 640, 39 

property, marked difference in ..... 501, 97 

property of blood . *505, *506, *507, *511, 513, *516, 523, 529 

property of blood, illustration of high and low defense . *516, *102 



Bactericides 

Base 
calcium, for neutralizing acids 
for neutralizing acids 

Bedridden 

patients with deforming arthritis 



526, 125 

540, 402 
540, 402 

. 175 



Biological 

and morphological characteristics and local and systemic tissue 
expressions related . . ..... 58 

factors and Mendel's Law . . 589 

qualities of organisms involved in root end infections . 56, 66 

units in dental focal infections (unicellular and multicellular) . 569 

Bladder 

infection and cystitis ....... *165, *166 

infection of ......... . 163 

ulcer and cystitis ... ..... *272 

Blindness . . *326, *329, 331, *346 

progressive .......... 344 

Blood 

acid-base relation of, to symptoms and treatment . . *558 

acid-alkali balance of ...... . 542, 563 

alkalinity index of ... . . *557 

alkali reserve of, and clinical symptoms, related in the healing of 
sockets .......... 352 

and its defensive mechanisms .... 322, 529, 615 

bactericidal power of . . *531, *537 

""Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



422 



COMBINED INDEX FOR VOLUMES I AND II 



Blood -(continued 

bactericidal property of *505, *5C6, *507, *5C8, *5C9, •511, 

illustration of high and low defense 

marked difference in 
calcium ..... 

as related to clinical conditions of individuals 

changes produced by infected teeth 
chemical analysis, marked difference in 



tPACE 

>516, 523, 529 

. *516, *102 

97 

87, 154 

607 

*254, 328 

241, 97 



of leucocytes to 



241, 
determine 



84 



dental pathology and systemic in- 



chemical changes in, by implantations, and relation of ionic cal- 
cium to body weight ..... *257 

chemical changes produced by dental infection 241, 632, 31 

chemical constituents of, and systemic disturbance (sensitiza- 
tion) ... 388 
chemistry 

abnormality of . 

and physical expressions 

defense . 
and tuberculosis 
as compared with 
volvements 
need for 
count 

compared with general circulation 

of over 1003 animals discloses different strains of organisms 
which may produce different results .... 

culture ....... 

decreased bactericidal content of, and susceptibility to 
defensive factors of, variations in . 

hematological changes produced by dental infection 
high pressure ....... 

produced by dental cyst 
hydrogen ion concentration of .... 

morphology, comparison of changes. 
of rabbits, morphological and chemical analyses 
response, tooth toxins compared with bacteria of tooth 
stream ........ 

cultures ........ 

infection of 

seriously affected by toxic substance from irritant . 
sugar in, see Hyperglycemia 
vaccination in vitro . . . . . 501, 526, 529, *99 

Walker Index of .237 



504 
122 

*242 
245 

47 



234 

62 

501, 82 

501, 640, 39 

234, 632, 31 

. 110 

. *111 

542 

*258, 560 

. 545 

. 510 

*63 

. 128 
635, 33 



Blood-Born Infection . 
Bloodshot 

Bone 

absorption of .... 

alveolar 

cross section of . 

destruction of ... 

streptococcal infection in 
changes, different types . 
condensation of, and poor defense . 
dense ..... 

destruction, evidence of, whether teeth properly root filled 
maxillary, widened to develop bones of face 
normal and pathological, roentgenographic appearance of 
•Illustration or chart 
tl'lam face figures, Vol, I; l*>l<l face, Vol. II. 



. 126 
341 

41, 68, 78,89 



68, *70, *72, 470, 



*473 
112 

226 
*241 

109, 53 

45, 74. 77 

199 

436, *438 

•471, *472 



COMBINED INDEX FOR VOLUMES I AND II 



423 



tPAGE 

Bone — (continued) 
of rabbit, different types of reaction in . . .71 

osteoid ... ... 391, *392, 393, *394 

osteoid, filling in 139, 148, 499 

radiopaque and radiolucent, as related to ionic calcium of blood 608 
reconstruction, about apex ....... 75 

streptococcal infection in ...... . 487 

surrounding roots (roentgenographic evidence of same) . 77 

Brain 
cortex, lesion from dental infection . 
diseases ...... 

fatty degeneration of, from dental infection 
infection ... 

lesion, production in rabbits 
poor repair of .... . 

Breath 
shortness of . 



Bright's Disease 
and dental infection 

Bulging Eyes .... 

and retinal hemorrhage .... 

Calcification 
and tubercular defense .... 

arrangement of structures 

groups ...... 

of pulp .... 489, 490, 

and arthritic changes in external surfaces 
osseous, hyper, and hypo 



k 493, 



within pulps beneath caries 



*278, 279 
314 
280 
*295 
325 
305 

45 

*462, 155 

. 252 
. *336 



121 

. *471 

68, 90, 109, 242 

*494, *498, 227, 242 

*495 

*70, *72, 242 



*137, *140, *144, *146, *147, 148, 152 



540, 641, 39 

641, 40 

*544, *561 

552 

*547 

. 586 

540, 402 

241, 633, 31, 154 

257 

358 

248 



Calcium — See Ionic, Blood 

and acid-alkali balance ..... 
dental infections disturb their relationship 

and the relation of alkalinity index to 

and whether or not we can tell if quantity is sufficient for body 
and blood stream ..... 

as it relates to alkalinity index 

balance disturbed in various sera of body 

base for neutralizing acids .... 

changes in blood ...... 

compound, studies to determine nature of 

determinations of saliva and blood as related to dental caries 

determinations, variations in, as made by different methods 

ionic of blood 

a factor in the healing of sockets ...... 352 

changes, compared with blood morphology, due to culture *258 

changes in and various determinations .... *534, 540 

changes produced by infected teeth .... *254, 455 

depends upon high or broken defense . . . . 431 

depressed by implanting infected teeth .... *258 

effect of treatment ........ *251 

low or high, depending upon conditions . . .261 

of blood and saliva, important role in the etiology of periodon- 
toclasia ......... 354 

of rabbit changed by implantation . . . 503, 587, 608 

lack of, lowers defense to infection . . . 241, 638, 37 

■"Illustration or chart 
tPlain face figures, Vol. I; bold face, Vol. II. 



424 



COMBINKI) INDEX FOR VOLUMES I AND II 



433, 



•434, 535, 549 

59. 400. 404 

421. 400 

551, 607 

265, 97 

416, 85 

609 

406 

241, 79 



Calcium continued 

lactate given to raise ionic calcium of blood 
metabolism . . . 

and endocrine glands 

considerations in connection with 
reserve in relation to pregnancy 
rich diet .... 
role of, in life and metabolism 
should be increased during pregnancy 
very low, case of 

Canal 
Fillings 

efficiency related to solvent 

rarely shut out bacteria .... 

reduction in efficiency of 

relation of danger to activity of patient's defense 
Medications 

difficulty in sterilization .... 

frequent injury from .... 

overstrong medicament < 

Cancf.r 

of stomach ...... 

skin .... . . 

Carbohydrate Metabolism 

and dental infection 

may produce hyperglycemia and glycosuria 

may produce marked changes in 

probably injure Islets of Langerhans of pancreas 

Carditis ....... 

chronic, inherited susceptibility to . 

Caries 

and pulp infection 

deep, pulp generally infected 

moderate, pulp frequently infected 
and systemic involvement 

proportional, as related to symptoms 

proportional, both as cause and effect 
arrested, microscopic appearance of section 
as calcium of the blood and saliva are related to it 
deep or moderate, may or may not involve pulps 
dental .... 

increase of 
etiological factors in 

and acid-producing bacterium 

and change in the chemical constituents upon bathing fluid 

dependent upon reduction of hydrogen-ion concentration 
irritating and causing pulp changes . *140, * 

related to 

susceptibility in 681 individuals • . 

susceptibility to rheumatic group lesions 

systemic susceptibility 

type of rheumatic group lesions 
with pulp necrosis ... 

Casts 

from dental infection ... *462, "109, 170. 

•Illustration <>r chai t 

tPlain face figures, Y<>|. I; hold face, Vol. II. 



184, 631, 29 

184, 631, 29 

181, 199. 631, 29 

184, 199,631, 29 

184, 631, 29 
184. 631. 29 
184, 631, 29 

. 269 
392, *393, 355 

. 362 

398, 637. 35 

398. 637, 35 

398, 637. 35 

398, 421. 637, 35 

133 
90, 285, *299 79 



133. 47 
(529. 27 
629, 27 
154 
629, 27 
629, 27 

358, 607 

133. 149 

404 

408 

358 

636, .Vr> 

6, 35 

636, .^ 

142. *143 



*155 
*155 
156 
•156 

131 

*171 



COMBINED INDEX FOR YOI.l'MES I AND II 



425 



C \ 1 ABOLISM 

disturbed by accessory food factors and toxic substances 

Cecum 

invagination of ...... 

Cell 

permeability 
reaction, a study of 

and Roentgen-ray treatments 
resistance and proliferation 

caused by radiation 

Cementosis 

hyper and hypo ...... 

Cementum 

ability to sterilize same by medication 
and dentin 

repair in 

repair rare . . 

attacked and destroyed . 

Central Nervous System 
disturbances 

reproduced in rabbits 

Characteristics — See also Organisms 

of dental infections and local tissue pathology related 

susceptibility ..... 

of morphology and biology and local and systemic 

sions ...... 

of organisms, biology 

of organisms, morphology 

Charts — See Table of Charts in front of book 
for rheumatic susceptibility 
showing inherited susceptibility 
showing stomach involvement 



fPAGE 

. 550 
252, *255 

336, 213 

. 575 
. 593 

336, 635, 33 
*244 

188, 198 

. 391, *392 
393, *394, 395 

. 481, *490 

273, 306 
265, 285, 273 



Chaulmugra Oil 

compounds used in periodontoclasia 
injections ..... 
used in the treatment of leprosy 

Chemical 

analysis of blood 
basis for groupings 
changes in blood 

dental infections produce serious 

development of acidosis 

development of nitrogen retention 

development of products of imperfect oxidation 

increase in blood sugar 

increase in uric acid .... 

ionic calcium .... 

presence of pathologically combined calcium 

reduction of alkali reserve .... 
changes in caries 
means for increasing defense 

results encouraging 
*Illustration or chart 
tPlain face figures, Vol. I; bold face. Vol. II. 



to degree of 

. 110 

tissue expres- 

58 
56, 66 
55, 66 

. 285 

. *318 

*247 

*260 

. 349 

*331, 333 

. 329 

241, 97 

241, 123 

. 241 

241, 632, 31 

540, 555, 633, 31 

241, 633, 31 

241, 633, 31 

241, 633, 31 

241, 633, 31 

241, 540, 633, 31 

241, 633, 31 

555, 633, 31 

358, 636, 35 

. 329, 526 

635, 33 



426 COMBINED INDEX FOR VOLUMES I AND II 

tPAGE 

Chemicals See also Medicaments 
as a means for increasing defense *330 

Chemistry 

blood .... 241,540,555 

and tuberculosis .122 

need for . . 245 

shows abnormality . 84 

Chemotaxis 

a reaction of, with toxin . *502, 620 

as a means for increasing defense 329 

results encouraging ..... 635, 33 

caused by decrease of leucocytes for reaction from dental infections 532 

Children 

break earlier than parents 90, 50 

may die from heart disease from infected deciduous teeth . . 59 

Chilling 
as an overload ........ 265, 283 

Chloralhydrate 

efficiency of, for the sterilization of infected teeth . 186 

Chloramin-T See Chlorazene 

Chlorazene (Chloramin-T) 
efficiency of, for the sterilization of infected teeth 186, 188, 192, 208 

Chlorine 
compounds, used in periodontoclasia ... . 349 

Chloroform 

dissolving gutta-percha for root fillings ... 202 

Chloropercha 

used in root fillings ........ 200 

Chlorophenol 
efficiency of, for the sterilization of infected teeth . . . 186 

Cholecystitis 285, *295, *253, *256, *258 

Cholelithiasis 285, *295, 256 

Chcrea 2£5, 2?4. 314. *315 

and dental infection ... 57. *278, 279 

of dental origin ........ 312, 313 

Choroid 

hemorrhagic infiltration into ...... *293, 341 

Circulation 

disturbances, local and general, from dental infections . 252 

Circulatory System 54 

lymphatic circulation ....... 519. 228 

Clinical 

and physical conditions as related to the blood . 248, 607 

studies of tuberculosis . .... 120 

symptoms and their relation to the removal of dental infections . 565 

Clotting Time 
lengthened in rabbits . . . . 241, 77 

Cloves, Oil of 
efficiency of, for the sterilization of infected teeth . 186 

'Illustration or chart 

(Plain face figures, Vol. I; bold face, Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 427 

tPAGE 

Coccus 

dominating organism found in dental tissues involved . . 56 
only organisms found in root canal infection through animal 
passage ....... 66 

Cod Liver Oil 372 

Colds 

recurring, and dental infection .... 364, *131, 132 

Colitis 285, *295, 258 

acute .......... 250, 263 

spastic .......... 386 

Colleges, Dental 

responsibility of ......... 53 

Colored Persons 
more susceptible to heart disease . . . . . .51 

Comfort 
and safety .......... 397 

as a symptom ........ 210 

lack of reaction a danger constituting a paradox . . 631,29 

local comfort not an index of safety . . . 631, 29 

not a measure of safety ........ 390 

of teeth, not a measure of success of operation . . . 210, 214 

Community 
and health problems ........ 55 

causes of heart trouble one of most important . . . 285, 55 

Compensation 

supreme, of dental practice ....... 192 

Complications 

of pregnancy ....... 265, 406, 96 

tendency to . . . . . .83 

Conclusions 
regarding 

calcium and acid-alkali balance of blood .... 553 

changes in supporting structures of teeth, due to infection and 

irritating processes ........ 485 

chemical changes in blood by dental infections . . 263 

chemotaxis as a means for increasing defense .... 335 

comfort and serviceability a measure of success of operation 214 

constancy and efficiency of root fillings .... 209 

contributing overloads to defensive factors .... 382 

dental infections 

and pregnancy complications ..... 406 

and tissue and organ degeneration ..... 567 

causing marasmus ........ 405 

producing serious changes in blood and sera of the body 240 

dental involvements caused by arthritis .... 500 

efficiency of root canal medications ..... 198 

elective localization 

and organ defense ........ 324 

and tissue and organ susceptibility ..... 308 

environment provided by an infected pulpless tooth .316 

etiological factors in dental caries .... 363 

general . ....... 626, 404 

infection expressing itself in bone as absorption ... 89 

illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



428 COMBINED INDEX FOR You MES I AND II 

CONCLUSIONS— (continued 

methods for reinforcing a deficient defense 539 

morphological and biological characteristics of organisms 66 

nature of discharge from dental fistula 183 

nutrition and resistance to infection 420 

pathology of gingival infections (periodontoclasia) 356 

precancerous --kin irritations 397 

quantity, systemic effect, and tooth capacity 227 

radiation effects on dental pathological lesions 343 

relation of 

caries to pulp infection- . . 149 

dental caries to systemic disturbance- 157 

extent of absorption to danger . . 175 

glands of internal secretion to dental infections and 

developmental pro 

irritant to type of reaction ... 328 

periodontoclasia to periapical absorption 166 

periodontoclasia to pulp infections 153 

periodontoclasia to systemic disturbances . .162 

relationships between local and systemic reactions 119 

researches on dental infections and carbohydrate metabolism 498 

roentgenograms ... 54 

roentgenograms deciding dental infection 132 

spirochete, ameba, and other non-streptococcal infection- 111 

susceptibility of individuals . 108 

the nature and function of the dental granuloma 

the nature of sensitization reactions 391 

toxic substance formed in pulpless teeth 233 

variations in the defensive factors of the blood and serophytic 

microorganisms ........ 523 

Condensing Osteitis 68, 109, 167, 97, 176, *177, *180, 211. 249, *2S8, 627 

accompanying low defense . . * 1 01 

Conjunctivitis . 285, *293, *332 

Cortex 

of brain, lesion from dental infection . *27S, 279 

Cough 

streptococcal ...... .113 

Creatin 

in urine and bloo:! in humans and experimental animals 562 

Creatinin 

in urine and blood in humans and experimental animals 562 

Creosote 

efficiency of, for the sterilization of infected teeth 186 

Crown See Gold 

Crying ... *304 

CULTURE See Medium. Blood, Dental, Pulp 

O i ii re Medium See Media 

Cm ii RES 

aerobic and anaerobic, comparison of, in root-filled teeth 62 

dental, injection of, kill- fetal forms of rabbit " 107 

filtrate of, caused toxemia ..... 63 

from tooth and tooth toxin, comparison of . *32'i 

•Illustration or chart 

tin lace figures, Vol. I. M<1 II. 



COMB INK l> INDEX FOR VOLUMES I AND II 



429 



ll'.V.h 

. 222 
. 519 
. 65 

163, *274 
165, *166 

. *272 



*222 

. *380 
*381, *382, *384 
*220 
. 45 



Cultures— (continued ) 

infected, placed in pulp chambers 

mixed, inoculated, recover generally coccal group 

whole, and washed organisms, comparison of 

Cystitis ........ 

and bladder infection ...... 

and bladder ulcer ....... 

Cysts — See also Dental, Muscle, Ovarian, Vas Deferens 
contents ........ 

mandibular ........ 

maxillary ........ 

membrane ........ 

presence established by examination of aspirated material 

Danger 

and symptoms 167, 210, 641, 642, 40 

as apical absorption relates to it 

extent of area not a measure ..... 630, 28 
related to high resistance . . . . . 630, 28 

Deaths 

caused in twelve hours by spontaneous hemorrhage . 

*304, *305, 306, 85, *86, *88 
from heart disease ........ *299 

in children from deciduous tooth infection .... 59 

related to age and sex . . . . . .51 

percentage from heart ........ 407 

Decalcification 
extending from caries to pulp 
process ....... 

and tubercular susceptibility 
surrounding periodontoclasia pocket 



. *141, *142, *143 

470, 486, 107 

. 121 

. 474 

Defense 
affected by root canal fillings .... 215, 229, 631, 29 

against anaphylactic reaction to dental infection . . 388 

amount of, does not determine number of organisms destroyed . 620 
and contributing overloads . . ... 265 

and fistula discharge ...... 177, 630, 28 

and ionic calcium . . .... 241, 121 

and its ultimate decline from root-filled teeth and infection . 44 



and local and systemic expressions . 

and local reaction ...... 

as a factor in contributing overloads 

barricade of . 

broken 

and influenza ...... 

and periodontoclasia . 

and streptococcal invasion . . . . 

by faulty nutrition 
compared, patients and animals 
comparison of high and low . . . . 

deficient, methods for reinforcing 

vaccines ....... 

high, accompanied by periodontoclasia 

high and a vigorously functioning granuloma . 

high and low, and bactericidal property of blood 

illustration or chart 

tPlain face figures, Vol. I; bold face. Vol. II 



. 585 

109, 167, 289 

265, 633, 31 

. 442, 107 

265, 124, 125 

158, 344, 120 

265, 125 

. 416 

. 227 

90, 100 

539. 640, 39 

640, 39 

158, 344, *101 

. *460, *461 

501, *5I1, *516, H02 



430 



l i >MBINED INDEX IOK VOLUMES I AND II 



fPAGE 

l Defense continued} 

high or broken, establishes ionic calcium of blood 431, 551 

increased by chemical means ..... 329, 635, 33 

local and systemic, mechanisms of 610 

low, accompanied by condensing osteitis . . 109, *101 

low and high in patients, comparison of roentgenograms *514 

may be lost because of gingival infections 344, 636, 34 

mechanisms of 

against organisms of cocci group . . . . .311 

by which toxins are neutralized .... 65 

which protect tissues and organs of individuals . . 614,615 

of individuals, active or broken 118, 527 

of organs and elective localization 285, 318, 634, 32 

of rabbits against dental culture by injection of medicaments 329 

of rabbits and rats, to implantations ..... 522 

poor, and condensation of bone ..... 109, 53 

produces environment for organisms in dental focal infections 572 

provides in blood stream defensive factors suited to various 
tissues .......... 322 

quality of, and susceptibility of organs and tissues 298 
systemic, and the relation of gingival and apical absorption to 601 
to infection, lowered by lack of calcium and limitation of vita- 
mins 241, 416, 540, 638, 37 

tubercular, and calcification . 121 

type of operation indicated by, not symptoms . 109, 210, 642, 40 

variations in the factors of, of the blood ... 503, 529 

Defensive 
Factors of blood, Variations in .... . 241, 501 
marked difference in bactericidal properties of individuals 

501. *511, *516, 526, 640, 39 
this factor directly related to susceptibility classification 90, 640, 39 

Deforming Arthritis 63, *64, *65, 96, *174, *176, *177, *180, *181, *182, 

183, *194, 226, 264, 407 

and streptococcal pneumonia 
bedridden patient . 
of dental infection origin 
reproduced in rabbits 
susceptibility to 

Degeneration— See also Diseases 
fatty, of brain, from dental infection 
of pulp ...... 

of tissues and organs from dental infections 

Degenerative 

arthritis . *70, 94, 185, 193, 225, 287, 296, 298, 401 
myelitis 215, 216, 217 

Delirium 

from dental infection ........ 322 





265, 


►269 


128 
175 

407 


70, 


*72, 


*184, 


*197 






90 


198 
280 


215 


22Q 


250, 


*338 
567 



Dental 

attachments, arthritic involvement of 
caries ..... 
culture .... 

and heart involvement 

endocarditis in rabbits from 

exophthalmos produced in rabbits from 

•Illustration or chart 

tl'lain face figures, Vol. I; bold face, Vol. II. 



486, 128 

133, 154, 358, 404, 408 

57 

285, *299, 57 

285, *299, 60 

. 285, *293, *339 



COMBINED INDEX FOR VOLUMES I AND II 



431 






*291, *299, 57 

*547, *202, *208 

. *273, 274, *219 

285, *304, *305, *340 

262, 263, 377, 383, 386 

*378 

385 

*111 

73 

90, 167, 350 

. 406 

. 442 

639. 38 

639, 38 

442, 639, 38 

*223 

486 



tPAGE 

Dental— (continued) 

from pulp infection produces endocarditis and rheumatism in 
rabbits ..... 

osteomyelitis from 

paralyzed rabbit from 

spontaneous hemorrhage produced by 
cysts — See also Cyst . . .219, 

and heart involvement 

pathology of ... 

producing high blood pressure 

related to heart block 
diagnosis and prognosis . 
diseases, research institutes for 
granuloma, nature and function of . 

constitutes a quarantine station . 

name a misnomer 

not a neoplasm .... 

overgrown .... 

involvements, caused by arthritis 

multiple arthritis may attack attaching membranes of teeth 

486, 639, 38 

pulps of arthritic patients tend to become involved 486, 640, 38 

Dentin 
and cementum, repair in . . . . . .391, *392 

as it relates to the surrounding structures (dentino-cemental) 312 

attacked and destroyed . . . .481, *490 

sterilization, when infected, by medication . . . 188, 198 

Depression 
psychic ....... 

Dermal — See also Skin 
sensitizations developed in rabbits . 
test (extract of toxic substance taken from tooth) 
tests for sensitization, individuals responding to 

Dermatosis 

Diabetics 
and periodontoclasia ..... 
poor surgical risks ..... 

Diagnosis 
and treatment, incorrect ...... 109, 282 

dental, and prognosis ....... 90, 350 

dental diagnosticians require great knowledge of human body 643, 41 
dental, in general practice (with or without visible absorption) . 121 
for bacteremia ......... 62 



. 285 

. *390 
. *383 
. 598 

364, 392, *354 

241, 398, 103 
. 103 



importance of, in inherited susceptibility 

marasmus, a symptom for 

of teeth of arthritic patient 

what an adequate procedure involves 

Diarrhea 
obstinate ....... 

DlCHLORAMIN 

efficiency of, for the sterilization of infected teeth 

•Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



90, 53 

401, 637, 36 

. 494 

642, 41 

. *295, 263 

. 186, 188 



432 COMBINED INDEX FOR VOLUMES I AND II 

tPAGE 
I >ICHLORAMIN-T 

efficiency of, for the sterilization of infected teeth 193 

Diet 
deficiency 

an overload to dental infection- 416 

as a study to determine whether or not dental infections are 

more injurious in individuals with same 419 

effects of, to infection 416, 638, 37 

factors and ionic calcium changes in blood *534 

milk, to raise ionic calcium of blood 435 
normal and deficiency in rats to determine implantation effect- *521 

rich in calcium .... . 416, 85 

Digestive 

tract disturbance in patients; variability in elective localization in 

rabbits 
tract involvement . 285. *295, »255 

tract, may be disturbed by sensitization reactions 364, 63» 35 

Diphtheria 

as an overload ........ 265, 152 

Diplococci 
and streptococci, chief organisms growing in serophvtic microorganisms 

501, 641, 39 
found in dental tissues involved 56, i^d 

from arthritic joint .... . *292 

Gram-positive s2 

in smear from rheumatic joint *481 

Discharge 

from abscess caused by dental infection . *410 

from fistula *178, *181, 630, 28, 125 

constituted largely of neutralized products 630, 28 

more safe than absence of reaction . 630, 28 

pus may be an evidence of active defense 630. 28 

purulent uterine .421, 139, *144 

relieved by removal of dental infection . . 144 

Disc ussion 
general. . 569 to 643, 396 

Diskasks See also Brain, Bright's, Dental, Heart. Hip, Pott's. Ray- 
naud's. Rig 
degenerative 

and relationship between focal infections .... 
developed from implantation- 150 

produced by dental infections 566, 622 

1 )ISPI \U-.MK\T 

of third molar .... 262 

Doom 
impending ... 285 

Dosage 

quantity of 
in experiments, for comparison of infection 215, 219 

measured by injection of small glass tube in rabbits 220, 

to weight of rabbit, in elective localization 

small, fatal (one-millionth of a gram) 215, 58 

'Illustration <>i ch u t 

tPlain face figures, Vol. I: bold face, Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 



433 



■ [ ' \< .] 

. 347 
61 

*346 
. 345 

*66, 68 

85 






Dry Mouth Sec Xerostomia 

Dry Socket 

treatment of ..... 

Dyspnea 

Ear 

involvements ..... 

pain in, of dental origin 

Edema .... 

of kidney ...... 

Education 
and arthritis ......... 149 

Elective 

localization 57, 85, 86, 88, 89, 264, 333 

and organ and tissue susceptibility, relation between . 285 

and organ defense .... 285, 318 

diseased organs affect dental infections 
incompleteness of information . 
organisms influence organs 
and organism quantity factor 
and tissue and organ susceptibility 
definitely related to inheritance 
may be related to injury or lowered defense of involved tissue 

265, 633, 32 
not destroyed in dental infection by removal of organ in 

question 318, 633, 32 

obeys laws of Mendelism . . . *100, *104, 633, 32 

organisms from dental infections may or may not have 

elective localization . . . 285, 633, 32 

qualities found to be related to neither morphology nor sugar 

fermentation qualities .... 66 

quality of a strain decreases .... *304, *305, *307 

related to culture medium furnished by patient 427 

Emaciation 
as symptom of rheumatic group lesions . 

Emetin 
and Succinimid of Mercury injected for periodontoclasia 
and Succinimid of Mercury injected (sensitization) 

Emphysema 







634, 


33 






634, 


33 






634, 


33 




229, 


318, 


59 

285 




'. 90, 


633, 


32 



401 



348 
365 

128 



-See also Granuloma 



Empyema 
of antrum 

Encapsulation- 
of infection . 

Encephalitis . 
epidemic lethargic 

Endocarditis . 

acute in rabbits 

fatal 

from dental infection, fatality from 

heart involvement and toothache 

in heart of rabbit . 

in rabbits from dental culture 
*Illustration or chart 
tPlain face figures. Vol. I; bold face, Vol. IT. 



261 





*451 


, *453 


, *465, 


*109 












280 








215, 323, 


*324 


. 285, 


61, 


96, *105, 1 


*386 












*56 












*58 












57 










215, 












*548 












60 






434 



COMBINED INDEX FOR YOU MJ-.s I AND II 













57 
343 
55 
55 
55 




421, 

421, 


540, 
357, 


400 
361 



409, 410 

55, 95 

. 571 
. 311 
. 311 

634, 32 
215, 311,634, 32 

634, 32 



tPAGE 

Endocarditis— | continued | 
in rabbits from pulp infection culture 
malignant ..... 
pulpitis and heart involvement 
relation to dental infections 
relation to tonsils .... 

Endocrine 
glands and calcium metabolism 
system ..... 

Endowments 
needed ...... 

Environment 

accommodations of organisms to 

for organisms in dental focal infections 

furnished by an infected pulpless tooth 

produced by infected pulpless tooth 
host's only protection is exfoliation 
is a fortress for bacteria within the host 
organisms may pass out, defensive factors cannot pass in 
soluble poisions mav pass out and nutrition may pass 

in 311, 634, 32 

protected, of a tooth . . . . . 311,95 

Epidemic Lethargic Encephalitis ... .215, 323 

Epithelial 

structures, meaning and function of ..... 460 

Erythrocytosis 234, *235 

blood change produced by dental infection . . . 632, 30 
produced by tooth implantations ...... *235 

ERYTHROPENIA ... ... 234, *235, 79 

blood change produced by dental infection . . . 632, 30 
produced by tooth implantations .... . *235 

Ethylhydrocupreinhydrochlorate 

injections .... ... *330 

may have injurious effects on eyes when injected for pneumo- 
nia ..... . ... 333, 335 

used in the treatment of pneumonia ..... 329 

Eugenol 
efficiency of, for the sterilization of infected teeth . 190, 192 

Eucalyptol 

dissolving gutta-percha for root fillings ... 203 

efficiency of, for the sterilization of infected teeth 186 

Evidence 
absence of 167, 210, 361 

EXCEMENTOSIS .... *76, 201, 203, 242, *330 

showing marked ........ 7b, 82 

Excretory 

organs, kidney related to . . .155 

Exhaustion 
physical and nervous, as an overload to dental infections . 280 

nervous .......... 315 



Exophthalmic 
goiter ..... 

•Illustration or chart 

tl'lam f ice figures, Vol. I; bold face. Vol. II. 



421, *359, 361 



COMBINED INDEX FOR VOLUMES I AND II 



435 



tPAGE 

249, 252, 335, *336 
*339 



265, 633, 31 

276, *277 
265, 282 

87 

. 252 

. *336 

. 112 

. *293 



Exophthalmos 

produced in rabbits from dental culture . 

Exposure 
as a contributing overload which modifies defensive factors 

as an overload to lower defense and increase susceptibility to 
dental infections ...... 

as overload ........ 

Extraction 

rapid recovery after ...... 

Eyes 

bulging 

bulging, and retinal hemorrhage 

definitely improved by removal of dental infections . 

high percentage of localization in, when process is acute 

involvement 65, *66, 327, *329 

acute ......... *342 

in rabbit 285, *293, *328 

Facial 

neuralgia and neuritis, of dental origin .... *348, 349 

Factors — See also Defense 

contributing, to aid in diagnosis ...... 97 

Mendelian *100, 104 

Fear 

as a contributing overload which modifies defensive factors 

265, 633, 31 
Feces 

and urine, lack of control of . . . . . . 273 

Fetal 

forms dead following injection of dental culture into rabbit . *407 

Fetus 
may be affected by dental infections 

Fevers 



4C6, *407, 637, 36 



infective, as overloads . 
yellow ..... 

Fibrosis .... 

in pulps . . • . 

Fillings — See Root Canal Fillings 

Filtrate 
inoculation ...... 

of cultures inoculated into rabbits . 

Fistula 

and putrescent pulp .... 
discharge from ..... 

quality of, depends upon stage of defense 
discharge, nature of ... . 

constituted largely of neutralized products 
more safe than absence of reaction 
pus may be an evidence of active defense 
presence or absence of, not a measure of infection 
subjected to radiation in earlier days 
* Illustration or chart 
tPlain face figures, Vol. I; bold face, Vol. II. 



. 265, 152 
95 

*99 

*136, *140, *142, *151, *152, 484 



. 296 

62, 64, 66, 232 



177, 52 

*178, *181 

. 179 

630, 28, 125 

630, 28 

630, 28 

630, 28 

. 177 

. 336 



436 COMBINED INDEX FOR Vol. I MES 1 AND II 

Pace 
Formalin 
efficiency of, for the sterilization of infected teeth 186, 192, I 

treatment in dog's teeth 129 

used to determine ability of streptococci to adapt themselves to 
environment 59 

PORMOCRESOL 
efficiency of, for the sterilization of infected teeth 18(5, 192 

FlXKKALS 

one in ten a heart case . 53 

possible relation of dental condition- to same 53 

G all-Bladder 

infection . 285, *295, 110, 252, *253 

Gall-Stones . 24r> 

multiple 285, 257, *258 

General Summary and Restatement of Fundamentals . 

GINGIVAL See also Periodontoclasia, Infections 
infections 

a new meaning for 604 

an extreme case with much free pus *577 

their pathology and significance . 344 

a direct expression and direct measure of vital capacity 5, 34 

confusion between safety and absence of reaction 636, 34 

high defensive capacity may be lost 635, 34 

relative to ionic calcium and alkali reserve 636. 34 

results of loss of defense . . 636, 34 

('.LANDS 

axillary, involvement *67 

circulating (leucocytes) . 619 

endocrine, and calcium metabolism 241, 121, 540, 400 

of internal secretion and dental infections .421 

disfunction of, often corrected by removal of dental infection 

8, 37 

similar lesions often produced in inoculated animals 638, 37 

of internal secretions 

as related to dental infections and developmental processes 121, 431 

function improved by mechanical stimulation 435 

salivary, infection of .... . 365, *372 

sublingual . *369, *370. 371, *375 

hypertrophied . . *373, *374. *376 

Glycosuria See Sugar 

may be produced by dental infection and carbohvdrate metabolism 

3! 8. 637. 35 
Gloom ..... 285 

Goiter See also Thyroid 421, 357, *36€ 

exophthalmic . *359, .*<>! 

Gold 

crowns and heart murmurs .52 

Granuloma See also Dental 
almost no vascularization . *448 

a physiologically acting tissue 501 

a protective mechanism of "111.458 

compared with roentgenogram 39, 41 

•Illustration oi chart 

tPlain face figures, Vol. I; l*>ld face, Vol, II. 



COMBINED [NDEX FOR VOLUMES I AND II 137 

ll'AC.k 

Gr uwloma— (continued) 

comparison of, from patient and rabbit, latter caused by tooth 
implantation ....... "453 



. *443, 458 
. 467 

. *446, 458 

. 447 

48, 50, 51, *460 

. 442 



degenerating 

destroys large number of bacteria present 
highly vascular ..... 

interpreted by some scientific men 
showing extensive mass .... 

size of, is not measure of infection . 
types of, tested in suspensions of organisms and freshly infected 
culture media ... .... 459 

vigorously functioning, patient with a high defense . *460, *461 

Graphic 
expressions 
of ability of streptococci to adapt themselves to environment 59 
of types of lesions produced by different strains of streptococci 71 
of various types of streptococci ..... 57 

Grief 
as a contributing overload which modifies defensive factors 265, 633, 31 
as related to root-filled teeth and infection .... 44 

Group 
similarities, significance of . . . .68, 90, 397 

Guanidin 

relation of toxic substance in infected teeth and . . . 562 

Guinea-Pig 

immune to anthrax .... ... 286 

Gums 

hemorrhage from . . . . 241, 73 

Gutta-Percha 

behavior of, in root fillings . . . . 201, *202 

Healing 

of sockets after extraction . 351, 475, 608 

Health 

of patient versus service of teeth ...... 52 

problems of community ....... 55 

causes of heart trouble one of most important ... 55 

Heart — See also Carditis, Endocarditis, Myocarditis, Pericarditis 

97, 104, 105, *Frontispiece C 
and rheumatism . . . 285, *288, *291, *299, 83 

angina pectoris ........ *70, 71, 93 

block, dental cysts related to . 73 

disease .... 

colored persons more susceptible 
deaths from, in children, from deciduous tooth infection 59 

deaths from, increase rapidly after age of forty-five 51 

deaths from, per cents at different ages . .51 

incidence of, increases with age ...... 51 

over 90 per cent of individuals forty-five years of age and over 
have dental infection . . . .51 

relation of sex to deaths from .51 

function versus tooth function . . ... 43 

high fatality rate .... ... 100 

illustration or chart 

tPlain face figures. Vol. I; bold face. Vol. II. 



*299 
51 



438 



COMBINED INDEX FOR VOLUMES I AND II 



iI'a<,e 

59 

*360 

96 

. *378 

90, 54 

55, 54, 55 

54 

*299 

45 

50 

*90 

90, *78, *164 

73 

52 

*304, 85, *86 

53 

90, 407 

90, 48, *49 

90, *91 

84 

90, 57 

71, *72 

55 



HEART — (continued) 
involved by types of streptococci 
involvement ... 

and deforming arthritis 

and dental cyst .... 

and heredity 

and streptococcal invasion 

dental infection due to streptococci 

in elective localization 

may be better than expected 

mitral murmur 

severe, teeth in . 

showing in susceptibility study 
lesions vary according to age of culture and kind of media 
murmurs and gold crowns 
muscle, hemorrhage in 
one in ten funerals a heart case 
percentage of deaths from 
resistance and susceptibility 
strong for, in susceptibility chart 
trouble (involvement) 

and dental culture 
from angina pectoris 

one of most important health problems of community 

Hematological 
changes in blood, produced by dental infections 234, 632, 31 
most frequent leucopenia, erythropenia, ervthrocvtosis, hemo- 
philia 632, 31 

Hemolysis 
produced by tooth toxins 

Hemophilia ...... 

blood change produced by dental infection 
serious case of .... . 

Hemorrhage 
clotting time. 

lengthened in rabbits . 

relation to dental infection . 
from gums .... 
in sclera .... 
into heart muscle . 
into pulp as involvement 
muscle .... 

postoperative 

retinal ..... 
spontaneous ... 

caused death in twelve hours 

in kidney .... 

in rabbit, causing death 

produced by dental culture 

Hemorrhagic 

infiltration into choroid . 



. 510, *511 

73, *74 

285, *304, 632. 30 
252, 606 



77 

241, 77 

77 

241. 73 

. *340 

*304, 85, *86 

*283, *67, 68 

*304, *305, *307, 85 

85 

. 335 

*267, *Frontispiece C 

*304, 306, 85, *86, *88 

. *76 

306, *75 

. . . 306, *340 

. 341 



HEREDITY See also Susceptibility 398 

and arthritis 90, *193. *194. *195 

and heart involvements ... 90, 54 
as a contributing overload which modifies defensive factors 265, 633, 31 

laws of ... 590 

•Illu-tratioii or chart 

rPlain face figures, Vol. I; bold face. Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 



439 



*70, *72, 289, *290, *291 
. 374, *377, 562 



Herpes 352 

oral . *375, 376, "377 

zoster ........... 353 

High Blood Pressure — See Blood 

Hip 

disease .... 

Histamine 

inoculation and reaction effects 

Histological 

changes about teeth of arthritic patient .... *489, 490 
sections of tissues (kind of organism) . .56, *491 

Hydrogen Dioxide 
efficiency of, for the sterilization of infected teeth . . . 186 

Hydrogen Ion Concentration 

caries dependent upon reduction of ... 358, 636, 34 

identification for diplococcus ....... 56 

of blood . 262 

test of saliva to test improvement in periodontoclasia by radiation 339 

of periodontoclasia pockets . .351 



of saliva, as it relates to dental caries . 
of urine ...... 

of various fluids .... 

Hypercementosis 

Hyperglycemia — See also Sugar 

and effect of disturbance of dental infections 

may be produced by dental infection and carbohydrate metabolism 

398, 421, 637, 35 
to the calcium factors ....... 259, 398 

Hypertension 

Hyperthyroidism 

Hypertrophic 
nodule on root (arthritic) 

Hypertrophy 

of kidney ...... 

from dental infection .... 

Hypocementosis ..... 

Hypotension 

relieved by removal of dental infection 

Hysteria ...... 

Ignorance 
price of ..... . 

vanity of ..... . 

Illustrations— See Table of Illustrations in front of book 

Imbecile 
patient, median suture opened .... 

Immunity 

characteristics of active and deficient 

establishment of, in individuals 

from dental infections, phenomena of 
* Illustration or chart 
-(Plain face figures, Vol. I; bold face, Vol. II. 



. 359 

*558, 586 
. 542 

. *244 



426 



*111 

421, 357, *358 

. *496 

. 161 
*169, 170, *171 

. *244 

. 73 
. *316 

. 59 
50 



*437, *438 

. *323 

576, 604 
. 615 



440 COMBINED INDEX FOR VOL! MES 1 AND II 

(Page 
Immunity (continued 

quality of, to systemic involvement- 582, 610 

to dental caries . ' 3(33 

Implantations (rabbit i See also Tooth 
effect of passing tooth from animal to animal . 221 

effects in depressing polymorphonuclears and increasing lvmpho- 

cytes »238, *239 

in rabbit produces abscess »454 

of coin and its effect *225,*449 

of infected teeth, chemical changes in blood and relation of ionic 

calcium and body weight *257, 587 

of pieces of infected teeth in rats during pregnancy ' 408 

of teeth 65, 219, 234, 258, 316, 338, 404, 414, *451,456, 497. 503. 522, 560 
of teeth and result on supporting structures 191 

of teeth causing pneumonia -ji.ti 

of teeth in rats, expel teeth *524 

of teeth in rats (normal and deficiency test *521 

of teeth producing no irritations *463 

of tooth with infected cementum killed rabbit *196 

producing encapsulations about teeth * 451 , *465, *467 

reduced hemorrhagic mvositis . 85 

subdermal . *226 

tooth, and pneumonia 265. *269, 129. *130 

Indigestion 246 

nervous 246 

Infantile 
paralysis 95, 224 

Infection — See also Ameba, Gingival, Pulp, Spirochete, Streptococcal, 
Tooth 

acute ovarian, in rabbits 421, *137, *138 

184, 199, 44 

265, *316 

. 126 

126 

*295 

215 

632, 30 



and root-filled teeth 

as overload 

aspiration of 

blood-born 

brain . . ... 

capacity of root-filled teeth for 

not necessary that quantity be large 

organisms may pass to other parts of the body 632, 30 

soluble poisons may pass to other parts of the body 632. 30 

toxic substance may sensitize the bodv or special tissues 632, 30 

encapsulated 442. *451 '109 

in gall-bladder 2S5. >295, 110. 252. *253 

inspired mouth, in anesthesia 128 

nutrition and resistance to 416, 638, 37 

of bladder 163 

ol bladder and cystitis 165, 166 

of joint and arthritis 285, 288, 291, *173 

of lung and dental infections *269, '115 

of muscle torticollis . *205 

of the bood stream 128 

of tooth and sequestrum 107 

oral, inspiration of. 128 

ovarian, tubal *146 

in relation to syphilis _ 14(> 

quantity of, in putrescent pulp 215, r'l 

'Illustration <>r chart 

(Plain face figures, Vol. 1. lx>ld face, \<>1. II. 



COMBINED INDEX FOR VOLUMES I AND II 



111 



pancreas 
215, 57, 



Infection— (continued) 
spinal ...... 

streptococcal, in neck muscle . 

streptococcal, predisposes toward other attacks 

tubal .... 

Infection, Dental— See Tooth, Pulp 

acute and chronic, as overloads to dental infections 

acute neuritis from 

affected by diseased organs 

and asthma ..... 

and Bright 's disease 

and calcium and acid-alkali balance 

and carbohydrate metabolism . 

may affect fetus and expectant mother 
may produce hyperglycemia and glycosuria 
may produce marasmus and loss of weight 
may produce marked changes in . 
probably injure Islets of Langerhans of 

and chorea ..... 

and deforming arthritis . 

and facial neuralgia and neuritis 

and glands of internal secretion 

and insanity .... 

and lung infections 

and mucous membrane inflammation 

and nephritis 

and pneumonia 

and pregnancy complications . 

and recurring colds 

and rhinitis . . . 

and stroke ... 

and tuberculosis .... 

as related to endocarditis 

changes in supporting structures, due to 

delirium ... 

disturbances in other parts of body 

due to streptococci 

expressed as absorption 

expressing itself in bone as absorption 

expressions related to groups . 

fatty degeneration of brain from 

from dental infections, phenomena of 
a factor in disturbance of various sera of the body 
affect directly ionic calcium and acid-base balance 
and causative factors in systemic involvements 
and etiological factors in rheumatic group affections 
and local expressions . 
and microorganisms involved therein 
and systemic expressions 
as it expresses itself 

causes break when individual is subjected to overload 
changes produced in blood and sera of the body by 
contributing to skin irritation 
defense against, is decreased by faulty nutrition 
dental, contributed to by arthritis 
extent of is not a quantitative measure of 
* Illustration or chart 
tPlain face figures. Vol. I; bold face, Vol. II. 



|PAGE 

*72, *275, *276, 277 

. 204 

55 

136 139 



. 281 

. 285, *288, *310 

318, 634, 33 

. 364. 133 

398, 421, 155 

540, 555, 641, 39 

398, 637, 35 

406, *407, 637, 36 

398, 421, 637, 35 

401, 637, 36 

398, 637, 36 

421, 637, 36 

^278, 279, 312, 313 

*70, *72, 470, *476, *478, 407 

. *348, 349 

421, 638, 37 

. 285, 301 

265, *269, *115 

132 

*288, *290, 155 

265, *269. *130 

406, *407, *151 

364, *131, 132 

. 364, 131 

. 379 

. 118 

285, *299, 55 

470, 639, 38 

. 322 

285, 318, 627, 25 

55, 54 

. 68, 628, 26 

89 

68, 90, 628, 26 

. 280 

. 615 

600 

566 

118 

579 

. *174, 569 

. 409 

*93, 581 

. 109 

. 284 

234, 240, 263 

. 392 

. 416 

. 500 

. 574 



90 



of blood 



442 



COMBINED INDEX FOR VOLl MES I AND II 



tPAGE 



66, 



Infection— (continued ) 

may or may not contain organisms with specific elective 

localization 
removed and thyroid involvements subside rapidly 
to determine quantity of in various ca 

to what extent does it contribute to defeneration of tissues and 
organs .... 

tubercular, probably enters through cavities of dental caries 
which is similar and varied reactions 

which is similar in members of family tend to produce same 
type of tissue reaction ...... 

gingival ... 41, 577, 604 

in individuals, as carriers, eliminated by removal of dental infec- 
tions and caries . .... 

in over 90 per cent of individuals forty-five years of age and over 
in root canal fillings .... 

in root canal grows coccus 

involved in angina pectoris .... 

lesion in cortex of brain from 

local expression in different people . 

may apparently not injure in absence of an overload 

may produce precancerous skin irritations 

may sensitize patient or may disappear with the removal of 

364, 636, 35 
paralysis from 265, *273, *274, *271, *272, *274, 275, *2',6, 277 

periapical .......... 41 

caused by putrescent pulp . . ... 45 

produces hematological and chemical changes in the blood 

234, 241, 632, 31 
produces hvpertrophv of kidney .... *169, 170, *171 

obscure . .68, 109, 121, 167, 84 

oral, and influenza complications *267 

osteomyelitis in patient from ..... 540, *547, *228 

reactions from near and distant parts of body on supporting struc- 
tures of teeth ....... 47^ 

related to clotting time of blood 241, 77 



310 
424 

215 

555 

412 

69 

79 



413 

51 

209 

71 

71 

*278, 279 

68, 628, 26 

265, 633, 31 

392, 637, 35 



280, 



73 
144 

*281 

282 

55, 627, 25 

167, 628, 26 

. 341 



removal of, relieves hypotension 

removal of, relieves purulent uterine discharge 

rheumatic neuritis from ... 

sciatic neuritis from .... 

streptococcal ..... 

with little or no absorption .68, *88, 

Infiltration 

hemorrhagic, into choroid ..... 

Influenza 

and broken defense 265, 124, 125 

as a contributing overload which modifies defensive factors 265, 633, 31 
as an overload 265,92,116.124 

as related to root-filled teeth and infection . *267, 44 

as the greatest overload to transfer absent to acquired suscepti- 
bility ... 282 
complications and dental infections 265, *267 
virus ..... ... 126 

washings from nasopharynx dung of rabbit) . *269, *271 

•Illustration or chart 

(Plain face figures, VoL I; lx>ld face, Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 



443 



tPAGK 

Inheritance 

and susceptibility . . 90, 404 

definitely related to elective localization and tissue and organ 

susceptibility 90, 318, 633, 32 

of susceptibility 

90, 96, 118, 246, *247, 261, 283, *284, *286, 317, 329, 360 
and arthritis ....... 150 

for insanity ........ 90, 301 

for stomach involvement ...... 90, *268 

striking illustration . . . *93, *98, *100, *102, *104, 97 

Inherited Susceptibility and Mendel's law ..... 589 

Inoculation 

filtrate 229, *231, 296 



Insanity .... 

and dental infections 
cured ..... 
not related to dental conditions 
preventive measures as prophylaxis for 
susceptibility inherited for 

Institutes 
research, for dental diseases 

Insulin . 

Internal Secretions- 



299, 300, 301, 302, 303, 306, 307 

. 301 
. 309 



. 309 

305 

90, 301 

. 406 

398, 421, 363 



-See Glands 
Interpretation of Serological Studies ...... 600 

Interpretations — See also Conclusions 
bone absorption in dental infection in bone .68 

comfort and serviceability as symptoms of success of operation . 210 
dental, re medicated sterilization of infected teeth . . 184 

disturbances from streptococcal infections .... 615 

evidence of bone destruction and proper root fillings . 199 

medical and dental, dental infection factor in systemic involve- 
ments . . .117 
medical and dental, of organism involved . 55 
medical and dental, of roentgenograms . .37, 121 
medical and dental, re fistulae a measure of infection . . 177 
medical and dental, re flowing pus and systemic involvements 

117, 181 

of a new light on the phenomena of immunity and susceptibility to 
old and new ... ..... 626 

of inherited susceptibility and Mendel's law .... 589 

of literature re injurious substances (bacteria) in pulpless teeth . 229 
of non-dental diagnosticians on dental infections . 131, 167 

of patient regarding judgment of operator placing filling over pulp 138 
of professions and laity regarding the etiology of periodontoclasia 344 
of radiation reactions ........ 592 

of systemic involvements as overwhelming natural defenses by 
quantity of dental infection . . . . .215 

of the dental granuloma by some scientific men . . 447 

of the local phenomena of dental focal infection . . . 569 

of the mechanisms of local and systemic defense .610 

of the phenomena of local reaction ...... 573 

of the phenomena of relationships between local and systemic 
expressions ......... 585 

of the phenomena of sensitization reactions .... 596 

'Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



Ml ( OMBINED INDEX TOR VOU MES I AND II 

Interpretations continued) 

of the phenomena of systemic expressions of dental infection- 581 

of the relation of gingiva] and apical absorption to systemic defense (>01 

of the relation of local tissue reaction to calcium metabolism 606 
serological studies 

wrong diagnosis ol case of neuritis . -58 

Intestinal 
stasis . . 259 

Intestines . . 285. *295, 258 

Invagination 

of cecum 252, "255 

I ODIN 

absence of, causes thyroid involvements . 422 

efficiency of, for the sterilization of infected teeth 186 

preventing pathological process of goiter . 564 

Iodin Creosote 

efficiency of, for the sterilization of infected teeth 192 

Iodoform 
in root fillings, environment for streptococci 60 

saturated in alcohol 

used to determine ability of streptococci to adapt themselves to 
environment 61 

Ionic Calcium 87, 399. 401 

and alkali reserve and gingival infections 344, 540. 636. 34 

and arthritis 241, 192 

and defense . . 241. 501. 540, 121 

and kidney function 168 

deficiency 540. 555, 229. 230 

low 241,84 

Ionization 
as a disinfectant through pulp canal 190, 197 

used to test passing of medicaments from pulp chamber through 
dentin and cement um 313 

Insulin 

injected into rabbits to reduce blood sugar 

Irritants 
mechanical. Nature's reaction to 44, 

of skin (precancerous) 
related to type of reaction 

two types present, bacterial and toxic 

toxic, seriously affects blood stream 
illation of, to type of reaction 
skin, these may be produced by dental infections 

Ischemia .... 

Isi ETS 
of Langerhans of pancreas 363 

probablv injured by dental infection and carbohydrate metab- 
olism' . 398. 421. 637. 35 

Joint 
infection and arthritis 285, *288. *291. *173 

JUDGMENl 

need for basis for 93 

'Illustration or chart 

[Plain i ice figures, Vol. I; bold face, Vol. II. 



125, 


550, 


564 


9, *463, 


575. 


604 
397 




325. 


*327 






1. 33 




33 






328 


364. 392 


i. 63< 


35 

172 





168 




161 


. *169. 


170, *171 


66, *167, 


168, *294 




85 




71, *72 




*76 


90, 285, 


318, *156 




155 




*160 



COMBINED INDEX FOR VOLUMES I \M> II 445 

Page 

Kidney 

function and ionic calcium 
hypertrophy of 

from dental infection 
involvement 

edema 

from angina pectoris . 

spontaneous hemorrhage in 

susceptibility to 
related to excretory organs 
section, nephritic, with pus 

Lactation 

a period which contributes to susceptibility to rheumatic group 
lesions ... 406 

Lamina Dura 

abnormal condition of ... 45 

Langerhans 

islets of . 398, 363 

Lassitude 45, *316 

Laws 

of Mendelism .... 95, 589 

Lesions — See also Tissues, Organs, Pathological 
analysis of 

of different rabbits, inoculated with, joint and muscle involve- 
ment .... . . *291 

in elective localization *293, *295, *297, *299 

aortic arch .... 

brain, production in rabbits 

dental pathological, effects of radiation 

prevalence of, in affected patients . 

relation of local to svstemic .... 

skin . . . " . . 364, *381, *385, 392, *393, 355 

special tissue, dominance of, in patients and families . *104 

spinal ... ... *273, *274, *190, *293 

types of, produced by different strains of streptococci 71 

Lethargic Encephalitis .... . . *324 

epidemic . . 215, 323 

patient having same, implantation of in rabbits . 414 

Leucocytes 

as circulating glands which pass to every tissue of the body 619 

capacity for reaction decreased by presence of dental infection 532 

contain activating substance capable of inducing cell defense 395 
from fistulae . *182, *183 

migration of, in a glass tube *502 

type of, found in sockets of extracted teeth 351 

Leucocytosis 

produced by tooth implantations *236 

Leucopenia ..... 79 

blood change produced by dental infection "237. 632, 31 

Liver *253 

* Illustration or chart 

tPlain face figures. Vol. I; bold face. Vol. II. 



*297 
325 

343 
*104 
*174 



446 ( OMBINED INDEX FOR VOLUMES I AND II 

tPAGE 

Local See also Expressions, Reactions, Relationships, Symptoms 

expressions as related to systemic expressions . 585 

reactions 

and defense 109, 289 

groupings on the basis of 68, 90, 109. (528, 26 

nificance of inadequate 1G9, 167, 53 

Localization— See Elective 

Loss 

of memory ... *320, 322 

of sight ........ 333 

Ling 

abscess and pulmonary tuberculosis. 113 

infections and dental infections . 265, *269, *115, 134 

Lymph 

and its defensive mechanism to take care of invading organisms 615 
experiment with ..... ... *520 

human and animal, organisms growing in 519, 571 

Lymphatic 

circulation ... 228 

involvement .62 

Malignant 
endocarditis ....... 343 

Malnutrition 

as a contributing overload which modifies defensive factors 

265, 416, 633, 31 

Marasmus — See also Atrophy 

a diagnostic symptom ...... 401, 637. 36 

a symptom of rheumatic group affections . . 401, *4C3 

produced by dental infections 401, 637, 36 

relative to loss of weight ... 401,637,36,92 

Media 

artificial, organisms regrown in . 56, 73 

as an influence upon quality of elective localization 287, 308 

determines type of tissue involved — not organisms 75 

great influence on organisms found in dental infections 66 

kind in which organisms will grow .... 62 

variations of, influence organisms ... 59, 73 

Medicaments— See individual listing: 

Adrenalin, Alcohol, Arsenic, Chaulmugra Oil, Chloralhydrate, 
Chlorazene, Chlorine, Chloroform, Chloropercha. Chlorophenol, 
Oil of Cloves, Creosote, Dichloramin, Dichloramin-T, Emetin, 
Eucalyptol, Eugenol, Etnylhydrocupreinhydrochlorate, Formalin. 
Formocresol, Guanidin, Histamine, Hydrogen Dioxide, Iodin. 
lodin Creosote, Iodoform. Insulin, Succinimidol Mercury, Mercuric 
Nitrate, Mercurophen, Phenol. Quinine, Sulphuric Acid. Thymol, 
Thalium Sulphate, Trypsin, Zinc Compounds, Silver Compounds, 
Sodium Bicarbonate, Sodium Chloride. Rosin, Salicylates, Silver 
Nitrate. Salt of Ammonium Silver, 
ability of, to maintain sterilitv of root dressing sealed in an infected 

tooth . ... 186, *187 

for sterilization i subdermal implantations .... 227 

•Illustration or chart 

tPlam face figures, Vol. I: 1*>1<I face, Y<>!. II. 



COMBINED INDEX FOR VOLUMES I AND II 447 

1-Page 

Medication 

root canal ...... 184 

difficulty of sterilization ...... 631, 29 

efficiency of, for sterilization ..... 184 

frequent injury from ..... 184, 631, 29 

overstrong medicaments ..... 184, 631, 29 

Medium, Culture 

five per cent of pulpless teeth after root filling may be . 215, 43 

Membrane — See Mucous, Cyst 

Memory 

loss of *320, 322 



404 

. 107 

. 589 

. *100, *104, 583 

90, *100, *104, 314 

95, 589 



Mendelism .... 
analysis of data to see evidence of 
and inherited susceptibility 
factors .... 

illustrated . 

laws of .... 

obeved by elective localization and tissue and organ suscepti 

bility ... 90, 633, 32 

quality of organ and tissue susceptibility follows . . 3C9 

Meningitis 

spinal ..... . . 294 

Menstruation 
disturbed . ... 285, *297, 135 

Mental 

cloud 114, 283, 315, *316, 322 

deficiency in patient; median suture opened . . . *437, *438 

irritability 87 

strain makes individual more susceptible to dental infections . 275 

Mercuric Nitrate 

a drug used in periodontoclasia ...... 349 

Mercurophen 

efficiency of, for the sterilization of infected teeth . . . 186 

Mercury 
Succinimid of, 
amebacide and disinfectant, healing abscess .... 409 
and emetin injected for periodontoclasia .... 348 
and emetin injected for sensitization ... . 365 

Metabolic 

balance ......... 555, 398 

Metabolism — See Carbohydrate, Calcium 

calcium, disturbed in sera of body ...... 586 

calcium, disturbed by accessory food factor and toxic substances 550 
carbohydrate, as related to dental infections . . . 398, 427 

changed by removal of dental infections . ... 565 

disturbed by toxic substance from infected teeth (marasmus) 404 

disturbed within host by toxic substance formed in pulpless teeth 233 

process of . . . . . . . . . 543 

Microorganisms — See also Organisms, Serophytic 

of the mouth, growth factors of, in juices of living tissues . . 519 

Microscopic 
anatomy of the aorta . . . .61 

* Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



148 



COMBINED INDEX FOR VOLUMES I AND II 



. *262 

*437, *438 

. 129 



Molar 
third, displacement of 

\I< iNGOLLAN 

patient, median suture opened 

Moribund 

condition and streptococcal pneumonia 

Morphological 

characteristics 
changes in blood 236, 560 

of organisms 55 

related to biological characteristics and local and systemic tissue 
expressions . 58 

Morphology 

conclusions regarding 66 

Motherhood 

need for protection 406, 152 

Mouth 

infection, inspired in anesthesia 128 

Mucous 

membrane inflammation and dental infection . 132 

Multiple 

arthritis 

foramina, position of 

gall-stones 

pulp stones . 

Muscle 

atrophy 

hemorrhage . 

hemorrhage in heart muscle 

infection, torticollis 

spasm . 

spasm, cyst in 

system and skeletal system 

trapezius 

Myelitis 

degenerative 

Myocarditis 

♦Frontispiece C, 61, *80. 83, 8 
in rabbit 

new light on 

prognosis more favorable 
Myositis ... 

reduced hemorrhagic, from implantation 

\'i CK 

involvement 

in rabbit 
muscle, streptococcal infection in 

Ne< rosis 

area of, in pulp tissue underneath caries 134. 149 

in patient and in dog's mouth latter caused by arsenic 129 

ol spine *273, *274, *190 

process of, in otherwise perfectly normal tissue 611 

'Illustration or chart 
I'kim face figures, Vol. I: bold face, Vol. II. 





285, *288, 468, 639, 38 


50 


257. *258 


150, *151, *152, *338 


401. *402, 103. 95. 280. *281 


S3 




*304. 85, *86 




205 




221 




217 




401. 172, *205 




*205 


215. 216. 217 


>, 97. *98, 103. *105. 267. 289 


*304. *548 


83 


83 


57. 203. 205. 215, 217 


85 


116. *207. *219. *270 


215 




204 



COMBINED INDKX FOR VOLUMES I AND II 



119 



Neoplasms 

and cell function; radiation as treatment 

denned from granulation tissue 

dental granuloma not one 

not around root but a protective membrane 

skin irritations ... 

Nephritis 
and dental infection 
in kidney section, with pus 
interstitial 
parenchymatous 
produced by implanted tooth 
produced in a rabbit 
produced in rabbit by implantation 
produced with infected tooth chips . 

Nerve — See also Tissue 

degeneration of .... . 

tissues invaded by types of streptococci 



442, 



(■Page 

. 342 

447 

*451, *453, 639, 38 

. 458 
392 



167, 168, 289, 



161, 



*452, 



*294 

155 

*160 

*162 

*158 
*159 

*157 

*462 

158 



347 

58, 59 



301, *302, 311, 312, 



Nervous 

breakdown . .... 

exhaustion ..... 

indigestion ........ 

strain, as related to root-filled teeth and infection 
system 
and sense organs ...... 

breaks with acquired susceptibility caused by overload 
central, disturbances . . . *273, *274, 273, 306 

reproduced in rabbits . . *273, *271, 273 

culture from patient with symptoms of, inoculated into rabbit and 
produced arthritis . . . . 73 

Neuralgias 



360 

315 

246 

44 

269 

108 



facial and neuritis, of dental origin . 






*348, 


349 


obscure ...... 






347 


some cases furnishing explanation for so-called 






138 


Neuritis 




*117, 


134 


acute ....... 






*259, 


311 


acute, from dental infection 








*310 


and facial neuralgia, of dental origin 






*348, 


349 


looking for cause, teeth involved 








48 


rheumatic ..... 








283 


from dental infection . 






280, 


*281 


sciatic, from dental infection 






282 


severe ..... 


311 


Neurosis 




psychic 


322 


vasomotor ...... 








69 



New Light on the Phenomena of Immunity and Susceptibility 

to Disturbances from Streptococcal Infections 615 

Normal 

conditions, various factors in, found in health and disease . 586 

Nutrition 



and resistance to infection .... 
effects of deficiency diets not quickly expressed 
* Illustration or chart 
tPlain face figures. Vol. I; bold face. Vol. II. 



416, 638, 37 
416, 638, 37 



450 COMBINED [NDEX FOR VOLUMES I AND II 

fPACE 

Nl TRITION continued) 

lack of calcium lowers defense 416, 540, 638, 37 
limitation of vitamines lowers defense 416, 638, 37 
as it relates to localized community condition- 419 
faulty, as an overload to dental infections 279, 416, 583 
in infected pulpless teeth, soluble poisons may pass out and nutri- 
tion may pass in 311, 634, 32 

Obscure 

neuralgia 347 

Odontoclastic 

reaction ... .123 

and tubercular susceptibility 123 

Opacity -See also Radiopaque 

shadow of, in roentgenogram 48, 50 

Operation, Dental 

contributing overloads help decide . . 45 

depending on quarantine .44 

success of, measured by comfort and serviceability . 214 

teeth filling in ' .103 

Operative 

risks, poor 90, 103 

Oral 

herpes . 375, *376, *377 

infection, inspiration of . . 128 

Organisms— See also Bacteria, Strains 

See individual listing: Ameba, Bacillus, Coccus, Diplococci, 
Spirochete, Staphylococcus, Streptococcus 
accommodations of, to environment .55, 95 

characteristics of, and the lesions they produce in dental infec- 
tions. ..... 569, 575 

characteristics of, growing in infected teeth 61 1 

compared with strains .... .56 

dead, required to produce reaction in blood 529 

destroyed by blood of rabbit and patients . *506, *507, *516 

destroyed one wound by placing dressing on from another 
(defensive) factor ........ 506 

effects of, without filtering or washing .64 

from dental infections, may or may not have elective localization 

55, 285, 318, 633, 32 
grown from lesions developed in rabbits from dental infections still 

have elective localization qualities 320 

grown in lymph, animal and human *520. 523 

influence organs in elective localization and organ defense 318, 634, 33 
in infected pulpless teeth may pass out. defensive factors cannot 

pass in 311. 634 

injured by toxic factors in culture medium 230 

in root-filled teeth 62 

invading, determines tissue reaction 58 

involved in root canal and root apex infection 66 

not capable of passing from pulp chamber through dentin and 

cementum 314 

of root-filled teeth may pass to other parts of the body 311, 632. 30 
producing toxic substances .... ..'62 

qualities of, influenced by variations of culture medium 59, 66 

'Illustration or chart 
tPl.nn face figures, Vol. I; Md face, Vol. II 



COMBINED INDEX FOR VOLUMES I AND II 



451 

tl'V.I 

. 290 
215, 229, 59 
. 615 
. 222 
55, 56 
. *217 
. 537 
. 65 
*218, 229 
. 63 



. 615 
. 302 
318, 633, 32 
318, 634, 32 
. 155 
. *297 
59 
*297, 135 
. 64 
. *300 
;eneration 

. 555 



Organisms— (continued) 

quality of, to elect certain type of tissue . 

quantity factor of, and elective localization 

role of infecting, in dental infections 

sealed in pulp chamber . 

secured from dental tissues 

stained directly in the tubuli . 

used in making vaccines . 

washed, and whole culture, comparison of 

washed, injected into rabbit intravenously 

washed, inoculated, causes structural changes 

Organs 

and their defense against invading organisms . 
and tissue involvement of groups 
and tissue susceptibility and elective localization 
defense, and elective localization 
excretory, kidney related to 
generative (elective localization) 
internal, invaded by types of streptococci 
sex, primary and secondary .... 
structural lesions produced in ... 
susceptibility of ..... 
to what extent do dental infections contribute to the dej 
of 

Orthodontic 

pressure, cross section of tooth ...... *482 

procedures produce type of apical involvement due to trauma . 131 

Osseous 

calcification ........ *70, *72, 242 

spicules . . *72, 184 

Osteitis 627, 25 

condensing 39, 50, 74, 79, 82, 86, 88, 109, 111, *443, *471, *472, 486, 

97, 176, *177, *180, 211, 249, *288 
accompanying low defense . . . . . . *101 

rarefying . 39, 50, 74, 84, 86, 109, 111, 627, *180, 261 

and absence of rheumatic susceptibility .... 224 

Osteoblastic 

activity and defense for tuberculosis . . . . .124 

Osteoblasts 

activity of *483, *491, *492 

degenerating, beneath zone of caries ..... 148 

in process of removing alveolar bone in periodontoclasia . . *473 

Osteoclastic 

activity *220, 390 

and tubercular susceptibility . . . . 121, 124 

Osteoid 

bone 391, *392, 393, *394 

Osteomalacia 240 

and periodontoclasia 240, *241, *243 

Osteomyelitis .... *547, 103, *200, 203, 209, 227 

bactericidal capacity of blood of patient with .... *537 
chronic 191, 192 

* Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



112. 140. 


141. M42. 143 




*429, *142 




129, *137, *138 




*136. 139 




14*. 




146 




125. 428, *429 



I. .2 ( OMBINED INDEX FOR VOLUMES I AND II 

I'A< I 

Osteomyelitis (continued) 

from dental culture VI, -202, *208 

in patient from dental infection *547, *228 

maxillary, roentgenogram of . *547 

Other 
tissues 364 

Ovarian 

cyst 

reproduced in rabbits 
infection, acute, in rabbits 
involvements 
tubal infection 

in relation to syphilis . 

Ovaries 

as dental infections relate to them 

Overloads 265, 50, 92, 116, lis, 124. 211, 277, 316, 322 

and pregnancy 406, 150 

and arthritic cripples . *153 

and safety for root-filled teeth and infection 44 

chilling 265, 283 

contributing . 265 

chief contributing are: Influenza, Pregnancy. Malnutrition, 

Kxposure, Grief, Worry, Fear, Heredity, and Age 265, 633, 31 

to defensive factor . 265 

which modify defensive factor^ 265 
dental infections may apparently not injure in absence of an 

overload 265, 633, 31 

diphtheria as 265. 152 

exposure .... 265. 282 

help decide operation for root-filled teeth 199, 265, 45 

infective fevers as . 265, 152 

infection 265,301 

influenza 7. 92 

in patients, lowering defense 526, 583 

pregnancy as 26o, 406. 401 

Oxidation 
imperfect, in blood o55, 633, 31 

Oxygen 

tension, anaerobes are grown in . 62 

tension positive identification for diplococcus 56 

Pabulum— See Media 

Pain 
in ears, of dental origin $45 

P.m. ATi- 
obstruction of. in roentgenograms . 48. 51 

Palsy . . *310 

Pancreas 362 

Islets of Langerhans ol 
probably injured by dental infection and carbohydrate mc tabolism 

*430, 637. 35 
normal histology o\, of rabbit . *430 

pathological histology of. of rabbit *430 

substance from, injected into animals, lowers bkx>d sugar 399. 425 

'Illustration or chart 

tl'lam face figures, \<>1 I. I*>1<1 face, Vol II. 



COMBINED INDEX FOR VOLUMES 1 AND II 



453 



*273, *271, *272, *275, 



lI'AC.K 

. 2S7 

*276, 277, *292 

*273, 188, *189 

*273, 95, 224 

. *273, 219 

188, *189, 273 

: 273, *274, *276 



Paralysis 

from dental infection 

general . 

infantile 

in rabbit from dental culture 

of sphincters 

spinal . 

Parathyroid 

extract 421 

administrations of benefit, stimulation of pituitary *437, *438, 639, 37 

used to raise ionic calcium of blood of patient . 432, *434, 535 

used to raise ionic calcium of blood of rabbit . . 535 

removed from dogs ..... 432 

use of ........... 85 

Parenchymatous 

nephritis ..... 

Parents 
resistance of; children break earlier 

Pathological 

lesions, dental, and radiation effects 

Pathology 

dental 

as compared with blood chemistry and systemic involvements *242 
of gingival infections . . 344, 635, 34 

type, and susceptibility to tuberculosis 

different conditions of 

of dental cyst .... 

of gingival infections 

Peptic 

ulcer ........... *251 

Periapical 

absorption ..... 
as it is related to periodontoclasia 
involvement of root not sterilized by medicament (root dressing) 

Pericarditis . . ....... 

Pericementum 
destroyed 



*452, *462, *158 

90, *100, *104, 50 

336, 635, 33 



119 

41 

*451, 385 

. 356 



50, 51, 



Periodontoclasia . . . . 

accompanying high defense .... 
ameba infection found near region of 
and apical reactions, direct relationship between 
and broken defense 
and diabetics 

and its relation to pulp infections 
and osteomalacia . 
and pulp infection 

deep pockets, pulps generally infected 

moderate pockets, pulps frequently infected . 
and systemic involvement 

reduced susceptibility to rheumatic group lesions 

when appearing, an acquired factor 
and tubercular susceptibility .... 
as related to periapical absorption . 
* Illustration or chart 
tPlain face figures, Vol. I; bold face, Vol. II. 



164 
163 
185 

62 

. 45 

250, 264, 404 

158, 344, *101 

. 412 

163, 630, 28 

158, 120 

344, 103 

. 150 

240, *241, *243 

. 150 

150, 629, 27 

150, 629, 27 

. 158 

158, 344, 629, 27 

158, 629, 27 

119, 120 

. 163 



454 



( OMBINED INDEX FOR VOLUMES I AND II 



Periodontoclasia — (continued) 
a study of the bacterial flora in 
a study of the factors and types involved . 
cessation of development of pus not a cure for the lesion 
condensing osteitis surrounding 
discussion of causes for 
drugs most efficient in 
extreme case of 
pocket continuing to antrum . 
pockets, comparing elements contained therein 
jx)ckets of, deep or shallow, may injure pulp of tooth 
related to 

susceptibility to rheumatic group lesions 

systemic susceptibility 

type of rheumatic group lesions 
suppurative .... 
treated by Roentgen-rays 
treated with ultraviolet rays 

Peritonitis 
streptococcal 

Permeability 
of a tooth .... 
of cell ..... 

Phagocytosis 

from flowing fistula 

Phenol 

efficiency of, for the sterilization of infected teeth 



•171, 



tPAGE 

. 346 

348, 350 

338 

472 

344 

349 

*477 

41 

. 353 

. 153 

. *159 
*160 
. *161 
344, 134 
. 593 
. *339 



264, 265, 266 

*315 
. 213 

. *182 



. 186 
2' ; with organisms, in glass tube, injected into rabbit 
used to determine ability of streptococci to adapt themselves to 
environment ....... 



Phlebitis .... 

Photographs 
comparison with roentgenograms 
of extracted teeth . 

Physical 
strain, as related to root-filled teeth and infection 

Pituitary 

as it relates to development of the bones of the face . 
benefited by parathvroid extract administrations 

421, *437, 

Pneumonia 

and dental infection 

following implantation of infected tooth 

streptococcal . *269, 113, 116, 124, 126. 

and deforming arthritis 

and moribund condition 

recurring .... 

Poliomyelitis 

Polyneuritis . 

Postgraduate 

work ..... 

Pott's Disease *273, 236, 

•Illustration or chart 

tl'lain face figures, Vol. 1; bold face. Vol. II. 



61 
108, *110 

*42, *43, 47, *48, 50 
*43, *48, 51, *220 



199, 44 



436 



*438, 639, 37 




150 


'. *269, 


*130 




*466 


127, 279, 


282 


. 265, 


128 




129 




129 


. *273, 


306 




398 




412 


237, 238, 


277 



COMBINED INDEX FOR VOLUMES I AND II 455 

>l'\u< 

Practice 

dental, supreme compensation of . . .192 

Precancerous 

conditions 392, 118, 267 

and sensitizations ....... 392, 269 

causative factors of conditions of dental infections 

indirectly associated ....... 613 

of skin on nose ......... 393 

skin irritations ..... . . 364, 392 

dental infections may produce local sensitization reaction 

364, 637, 35 
Pregnancy 
as a contributing overload which modifies defensive factors 

406, 633, 31 
as an overload . 265, 401 



complications 
and arthritis 
and dental infections . 
and overloads 

and arthritic cripples 
calcium reserve related to 



406, 96, *151, 152, 185, *187, 188 
406, 146, *148, 149, 192 
. 406 
265, 150 
*153 
406, 540, 97 



chronic svstemie involvements begin with pregnancy 

406, *407, 637, 36 

dental infections may affect the expectant mother 406, *407, 637, 36 

dental infections may affect the fetus . *407, 637, 36 

in animals, effect of dental culture ...... 522 

in rabbit lowered resistance, causing pneumonia and death *273, *274 
lowers resistance and often favors development of rheumatism, 

heart involvement, etc. .... . . 268 

Present 

generation immature ........ 408 

Preventive 

measures, as prophylaxis for insanity ..... 305 

Prognosis 

and dental diagnosis ....... 90, 350 

for myocarditis more favorable ...... 83 

good ........... 213 

Programs 

intelligent one, value of ..... 53 

preventive .......... 45 

selection of . . ..... 46 

Proliferative 

arthritis *70, *334, 296, 401 

Protein 

compound produced by high temperatures, irritating or poisonous 467 

effects from injection into animals ...... 596 

injected parenterally into animals ...... 367 

sensitizations in individuals ....... 597 

Psychic 

depression .......... 285 

neurosis .......... 322 

Pulp Canals— See Root Canals 

""Illustration or chart 

tPlain face figures, Vol. I; bold face. Vol. II 



156 



coMlil.NKI) INDEX FOR VOLUMES I AM) II 



115, 



57 
149 

481 



. 229 

311 

442, 634, 32 

229. 311, 634. 32 



32 



Pace 
Pulpitis See Chapter VI I on Pulp Involvements 
and endocarditis 

and streptococcal infection 

disturbances from 

produced by orthodontic pressure 

PuLPLESs Teeth 

si udies of 

environment produced by 

host's only protection is exfoliation 

is a fortress for bacteria within the ho^t 

organisms may pass out, defensive factors cannot pass in 

311, 634 
soluble poisons may pass out and nutrition mav pass in 

311, 634, 32 
tooth toxins may produce very profound effects 215, 632, 30 

tooth toxins tend to prepare tissues of host for infection 

364, 632, 30 
tend to become infected 199, 229. 43 

they mav contain 5 per cent of culture medium even after root 
filling 199.215.43 

Pulps (See Chapter VII, Figures 65 to 80 1 

calcification of 190, *493. *495, 227, 242 

canal, capacity of, for infection 

capping, still more or less common 

culture 

decalcification of 

degenerated 

degeneration 

changes in, without caries 
hemorrhage in . . 

infection of 

and caries 

deep, pulp generally infected 
moderate, pulp frequently infected 

and periodontoclasia 

as caries relates to them 

as periodontoclasia relates to them 

culture produces endocarditis in rabbits 

culture produces rheumatism in rabbits 
involved, but not exposed, by deep caries 
involvement, hemorrhagic 
may be injured by deep caries 
of arthritic patients tend to become involved 
of teeth not comparable as to quantity of infection 
pathology of ....... 

putrescent 

and fistula ..... 

and history of soreness 

and their quantity of infection 

a study of root end infection 

related to acquired and inherited susceptibility 

with periapical involvement 





218 




133 




84 




*493 




250 




338 




484 




*483 


133 


154. 47 




629, 27 




629, 27 


150, 


629. 27 




. 149 




. 153 




215. 57 




215. 57 


*135, 


136, 137 


285. 318 


. *67. 68 




133 


470, 486 


640. 38 




69 


• 


497 




177. 52 




177. 52 




215. 52 




574 


•92. 


•94. *95 


45, 


57. *164 



stones, multiple 
Purulent 

arthritis 
'Illustration <>i chart 
• I'kini face figures, Vol. 



*140. *151, 492. 242. 338 



\38, *44. *67 



I. I). .id ! ice, Vol. II 



COMBINED INDEX FOR VOLUMES I AND II 



457 



tPAC.E 



Pus 



flowing from decayed teeth may or mav not have systemic 

117, 181 

183 

*292 

*160 

*89 



expressions ..... 

flowing from fistula is or is not dangerous 

from hip joint 

in nephritic kidney section 

in urine ...... 

synonymous with virulent infected organisms (fistulae) 177 

Pyelitis *160, *294 

Pyorrhea Alveolaris — See Periodontoclasia 

Quantity — See Dosage 

and systemic effect ....... 215, 160 

factor 

in fatality of rabbits *218, *290, 59 

of organisms and elective localization .... 285, 59 

Quarantine 

adequate .......... 108 

against dental infections ..... 578, 584, 593 

dental granuloma ... . . 442, 639, 38 

local, absence of . . . . . *88, 442, 93 

low capacity for maintaining . . . . 68, 43 

dental operation depending on .... 109, 44 

Quinine 

in bark chewed by natives of Peru to fight malaria . . 329 



Rabbits — See Implantations, Animal 
acute appendicitis reproduced in 
acute ovarian infection in 
blood of, morphological and chemical analyses . 
bone of, different types of reaction in 
brain lesion production in 
central nervous system disturbances reproduced 
clotting time lengthened in rabbits . 
deforming arthritis reproduced in . . *277 
eye involvement in 
nephritis produced in 
ovarian cyst reproduced in 
paralyzed, from dental culture 
quantity factor in fatality 
reproduction in .... 

spontaneous hemorrhage causing death 
torticollis in . 

washings from crushed teeth fatal to 
with endocarditis .... 

from dental culture 

from pulp infection culture . 
with exophthalmos produced by dental culture 
with neck involvement . 
with rheumatism, from pulp infection culture 
with typical deforming arthritis 

Radiations 
applied to neoplasms 
effects on dental pathological lesions 
affect pus and bacterial invasion . 
evidence cell resistance and proliferation 
"Illustration or chart 
tPlain face figures, Vol. I; bold face, Vol. II. 



264, *265, 267 

296, *297, *137, *138 

. 545 

71 

*273, *274, 325 

in *273, *274, 273 

241, 77 

, 285, *291, *184, H97 

285, *293, *328 

285, *288, *290, *157 

285, *297, 142 

*273, *274, *219 

215, 59 

. 136 

*304, 306, *75 

. *214, *218 

55, 215, 229, *231, 59 

285, 318, *56 

215, 60 

215, 57 

. *339 

. 215 

285, 318, 57 

285, 318, 63, *64 

. 337 

. 336, 592 

336, 592, 635, 34 

336, 592, 635, 34 







192 






338 






•341 






*340 












592 






33(5 




192. 


*339 




35 


, 176 


44 


171 


187 



458 COMBINED INDEX FOR VOL! MES 1 AND II 

Radiations continued 

quite definite 35, 34 

some definitely helpful and some definitely harmful 3! 635, 34 

from mercury vapor quartz arc 
to determine clinical effects in periodontoclasia 
to determine effects on bkxxl calcium of normal rabbit 
to determine effects on blood of normal rabbit 
to determine effects on dental pathological lesions 

reactions from 

tended to close fistulae; an early discovery 

ultraviolet 

Radiolucency 
and radiopacity 

Radiopaque 

anas over roots 

RADIUM See also Radiation 
used to terminate the tendency to malignant cell proliferation 593 

Rarefaction 

extensive zone of 50, 79 

produced by local reaction adequate 584 

Rarefying 

osteitis 68, 627, 25, 180. 2<>1 

accompanying high defense 109, * 101 

and absence of rheumatic susceptibility 109, 224 

Rats See also Animal, Diet, Implantations 

susceptibility to infection with the absence of vitamins . 418 

Raynaud's Disease ...... .69 

Reactions -See also Allergic, Anaphylactic, Apical, Local, Odonto- 
clastic, Sensitization, Systemic 
apical are less with decline of individual's defense against that 

infection 173 

compared in gingival and apical irritants 165, 603 

compared in patients and in rabbit . .73 

comparing type of, in different members of same family *80, *81, *82 
comparing type of, in individuals of various groups 83 

confusion between safety and absence of, in gingival infections 

163, 344. 636, 34 
different types of, in bone of rabbit 71 

from radiation ... 592 

local, most important characteristic of local dental infections 610 

local, the phenomena of 573, 584 

local tissue, found about teeth 110 

measure of quantity and type 118 

of infection from near or distant parts of body on the support- 
ing structures of the teeth . 477 
periapical, of patient *180 
relationship'- between local and systemic 113 
sensitization, the nature of 391, 596 
supporting structure changes largely an expression of the capacity 

for . 344. 639. 38 

type of, from food packs and gingival irritants . *161 

type of, related to irritant 
two types present, bacterial or toxic 325. 634, 33 

toxic, seriously affects bhxwl stream 325. 635, 33 

'Illustration or chart 
il'hin face figures, Vol. I. lx>l<i face, Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 



459 



Re wtions (continued) 
vary because different conditions occur at different periods 
(bone changes) .... ... 

vary in individuals from similar dental infections 

Recovery 

rapid alter extraction ... 

Relationships 

between apical reactions and periodontoclasia . 
between local and systemic expressions 
groupings on the basis of local reactions 
groupings on the basis of systemic reactions 

Repair 
of brain, poor 
of cement um, rare . . 

of dentin and cementum 

Reproduction 
in rabbits 

Requirements 

for advanced investigation 

Research 
institutes for dental diseases 



. l • \. .1 



85 
69 

325. 344 87 

163, 630, 28 

109, 628, 26 

68, 628, 26 

90, 628, 26 

. 305 

393, *394, 395 

391, *392 

136 



Resistance 

nutrition and, to infection 

effects of deficiency diets not Quickly expressed 
lack of calcium lowers defense 
limitation of vitamins lowers defense 

and susceptibility chart 
advantage of 
ancestral involvement . 
children break earlier than parents 
involvements of members of family 
nine cases of heart disease in same family 
of heart of Case 383, Figure 263 

Respiratory 
system 

Retinal 

hemorrhage . 

Retinitis ... 



416 



90, 



412, 413 

406 

416, 638, 37 

416, 638, 37 

501, 540, 638, 37 

416, 638, 37 

48 

48 

48 

*100, *104, 50 

'93, *98, *102, 48 

*49 

48, *49 

113 

. 335 
*326, *329 



Rheumatic 
group lesions and systemic reactions . 90, 628, 26 

dental infections are important etiological factors in . 579 

developed by complications of flu, pneumonia, or tuberculosis 265 
faulty nutrition contributes to the susceptibility to .419 

of individuals and relatives *93 

pregnancy contributes to the susceptibility to . 406 

related to dental focal infections (suscept. of patient) . *102 

susceptibility 

as caries relates to it- .... *155, *156, 157 

as related to systemic involvement and periodontoclasia 158, 629, 27 
periodontoclasia relates to it ... . *159 



neuritis 

from dental infection 
susceptibility 

chart for 



. 283 

280, *281 

280, 317 

. *318 



"Illustration or chart 
tPlain face figures, Vol. 



I; bold face, Vol. II. 



ICO 



COMBINED INDEX FOR VOLUMES I AND II 



45, 57, 68, 116, 180, 



fPAGE 

*234, *373 

195, 196, 207, 292 

285, *288, 83 

541 

532, *534 

90. 314 

57 

47, 50 

. 268 

58,67 

364, *131 

364, 596, *131 

364, 637, 35 



103 
103 



Rheumatism 
acute 
and heart 

and ionic calcium of blood (arthritic 
effect on, by administering salicylates 
hereditary ..... 
in rabbits from pulp infection culture 
of patient, caused by dental infections 
often brought on by pregnancy 
types of streptococci in . 

Rhinitis 

and dental infection 

and sensitization ..... 

may be produced by sensitization reactions 
Rigg's Disease— See Periodontoclasia 

Risks 

diabetics are poor surgical risks 

poor, operative ..... 

Roentgenograms 

at different angles . . . 41, *45, 48, 51, 53, 122 

conclus'ons regarding ........ 54 

conditions not d sclosed by . 37, 41, 45, 47, 50, 54, *123, *124 

compared with actual conditions 41, *44, *45, 47 

comparison of, in reactions from similar dental infections . 69 

comparison with photographic . *42, *43, 47, 48, 50, 51, 220 

density shown in, caused by surroundings . 41, 48 

difficulty in securing — anatomical complications 48 

evidence in, of a vigorous reaction about the tooth 84 

evidence in, showing limited reaction, with or without condensing 
osteitis ........ 

from patients with a low and high defense 

of condensing and rarefying osteitis 

of cysts 

of pockets with gutta-percha points 

of root fillings 

of teeth involving a skin lesion 

of teeth of sensitization patient 

revealing infection 

showing granulomata 

used as a final decision as to diagnosis of infection 

what thev will reveal ..... 



88 

451 

86 

45 

41 

45 

394 

387 

37, 124 

41 

. 132 

35, 627. 25 



*382, 
*369, 



Roentgenograph ic 
evidence, absence of . . . . . 35, 68, 62 

ROENTGEN-RAYS 

diminish flow of pus when infected teeth are exposed to . 592 

tended to close fistulae, an early discovery . 336 

Root Canal See also Root Fillings 

half filled produces radiolucency without granuloma . 77 

infected cultures placed in 222 

infection grows coccus . .66, 71 

medication 

difficulty of sterilization 184, 631. 29 

efficiency of, for sterilization ... 184 

frequent injury from ...... 184, 631, 29 

overstrong medicaments 184, 631, 29 

•Illustration or chart 
■ I'lain face figures, Vol. I; bold face. Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 



461 



fPAGB 

. 227 

45, 199, 454, 486 

199, 631, 29 

. 187 

. 209 

47 

194, *205 

. 199 

45 

199, 631, 29 

199, 631, 29 

199, 229, 631, 29 

51, 53 

. *207 

. 62 

. 179 

60 



Root Fillings 
are source of infection (conclusions) 
efficiency of . . . . . .41, 

efficiency related to solvent .... 

in infected teeth not sterilized by medication 

low percentage of, not infected 

molar ........ 

of tooth show definite infection (definite case) . 
physical state and properties of materials used in 
projection of, after absorption of roots 
rarely shut out bacteria .... 

reduction in efficiency of .... 

relation of danger to activity of patient's defense 167 

showing at different angles 

shrinkage 

testing of teeth to determine when they are ready for 

when favorable operations for certain individuals 

with iodoform ...... 

Root-Filled Teeth 
all under suspicion ..... 

contributing overloads help decide operation 
and subsequent infection 

defense and its ultimate decline . 
overloads and safety . 
capacity for infection 

not necessary that quantity be large 
organisms may pass to other parts of the body 
soluble poisons may pass to other parts of the body 

215, 229, 632, 30 
toxic substances may sensitize the body or special tissues 

364, 632, 30 
may contain 5 per cent of culture medium after root-filling 215, 43 

Roots 
absorption of . 45, 47, 112 

crooked 

density of, in roentgenograms 
penetration of 



167, 199, 45 

265, 45 

199, 44 

167, 199, 44 

167, 265, 44 

199, 229 

215, 632, 30 

215, 229, 632, 30 



radiopaque area over 

Rosin 
used with chloroform in root fillings 

Sacro-Iliac 

involvement ...... 

Safety 
and comfort ....... 

comfort not a measure of ... . 

demands of . 

factor and structural changes about infected teeth 

in root-filled teeth and infection 

Salicylates 

administered for rheumatism (animal and human) 

Saliva 
and a study of its pH as it relates to dental caries 
a study of, as related to elements in periodontoclasia pockets 
ionic calcium of ....... . 

* Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



*47 
41 
47 

44 



. 202 

. 134 

210, 397 

210, 390 

210, 52 

210, 215, 52 

210, 215, 44 



532 

359 
353 

541 



462 ( OMBINED tNDEX FOR VOU MES 1 AND II 

Pace 
Salivary 
glands, infection of 365, *372 

Saprophytic 

streptococci . 343 

Si i atic 

neuritis, from dental infection 282 

rheumatism *308 

Sc LERA 

hemorrhage in 340 

Sense 

new truth a new sense 27, 344 

organs and nervous system . 269 

Sensitization See also Anaphylaxis 132, 303 

and precancerous conditions 364, 392. 269 

and rhinitis 364. 596, *131 

as related to precancerous skin irritations and dental infections . 392 

by protein ..... 367 

dermal, developed in rabbits *390 

in patient, produced by dental infection- *371, *379 

in patients, caused by curettement . 364 

produced in rabbits . 365,*375, *376, *377 

reactions 364, 392, 356 

and a study Of the dental pathology 388 

nature of 

dental infections may sensitize the patient. 364, 636, 35 

may disappear with the removal of dental infection 364, 637, 35 

may produce a disturbance of the digestive- tract 364, 392, 637, 35 

may produce rhinitis or asthma 364, 637, 35 

produce anaphylactic reactions 364. 636, 35 

sensitizing substance may be very toxic 364. 636, 35 

the phenomena of . 596,610 

to tooth toxins . 

Septicemia 

streptococcal 314 

Sequestrum 

infected 69, 107 

Serologic vl See also Blood, Saliva, Urine Studies 

and local and systemic expressions .... 586 

an interpretation of .... 600 

Serophytic 
microorganisms, diplo- and streptococci chief organisms growing 
in same . ... 519, 641, 39 

Si x 
organs, primary and secondary . . . .21 

illation of, to deaths from heart disease 

Shadows 
objects causing .... 
o! opacitj in roentgenogram 

Shoc k 
expressions of, due t<> acidosis 

Sight 
loss of . 

'Illustration oi ch 
Plaii Vol. I; 1*>UI fac< . \<<\ II. 



•297. 


135 
51 




51 
48 




566 


•293. 


333 



COMBINED rFJDBX FOR VOLUMES I AND II 463 

i-Page 
Silver 

compounds used in periodontoclasia ... 349 

nitrate, efficiency of, for the sterilization of infected teeth 188, 192, 195 
salt of ammonium 188 

Similarities 

group, significance of . 68.. 90, 109, 397 

Skeletal 

and muscular system 172, *205 

Skin — See also Dermal 352 

cancer .... . . 392, *393, 355 

disturbances expressed as dermatoses 378, *381, *385 

irritations ... 364, 392, *393, *354 

are contributed to by dental infections .... 392, 612 

precancerous . . 392, *393 

these mav be produced bv dental infections . . 637, 35 

lesions " • • . • ■ 364, *381, *385, 355 

of rabbit from implantation of calcified root from arthritic 
patient ... . . . *497 

Sleepiness . 298, *300 

Sleeplessness 96, 264, 298, 299, *300 

Sockets 
of extracted teeth, variation in healing 351, 475, 608 

Soda 

bicarbonate of, to furnish to blood a cheaper base to neutralize 
pathological acids ....... 456, 549 

Sodium Chloride 

suspension of strains in . . 64 

Soreness 

history of, and putrescent pulp 52 

Spasm 
of muscle 285, 221 

cyst in 217 

Spastic 

colitis . 386 

Sphincters . 188, * 189 

paralysis of 273 

Spinal 

arthritis *72, 236, *237, 238, *239 



*72, *274, *275, *276, 277 

*190, *293 

. *274, *190 

*273, *274, *276 



infection 
lesions . 
necrosis 
paralysis 

Spirochete 

and ameba infections . 409 

may pass to other tissues ... 638, 36 

may produce systemic involvements *410, *411, 638, 36 

not usual . . ...... 638, 36 

from mouth entering body, may be rapid and severe *411 

Staphylococci 

found after culture injected from original focus. 56 

* Illustration or chart 
tPlain face figures. Vol. I: bold face. Vol. II. 



464 



COMBINED INDEX FOR VOLUMES I AND II 



*288, 295, *260 
. *268 
84, 246 
*304, 88 
. *251 
*248, 249, *251, 



55, 396, 403 
. 119 
. 113 



"Frontispiece, Vol. 



tPACE 

Sterilization 

difficult by root canal medications . ... 631, 29 

of infected teeth with medicaments 184, 195 

whether complete, through pulp canal, destruction of peridental 
membrane ....... 195 

Stomach 

cancer . 392, 269 

chart showing 
inherited susceptibility for 
involvement 
lesion . 
perforated 

ulcer .... *248, 249, *251, *267 

with perforation ......... 249 

Strains — See also Organisms, Bacteri 

difference in pathogenicity . 65 

different, found in dental tissues 56 

behavior of, from infected teeth . . 64 

washed, suspended ... 64 

Streptococcal 
adaptability ..... 

and tubercular susceptibilities, difference in 
cough ....... 

infection 

and pulpitis ..... 

bacteremia ..... 

comparing defensive efficiencies of blood 

immunity and susceptibility to disturbances from 

in alveolar bone 

in neck muscle . 

in torticollis 

predisposed .... 

predispose toward other attacks . 
invasion 

and broken defense 

and heart involvement . . 

dental infections due to streptococci 
peritonitis ..... 
pneumonia .... *269, 113 

and deforming arthritis 

and moribund condition 

recurring ..... 
septicemia ..... 
susceptibility .... 

susceptibility inherited . 
temperature ..... 

Strkptococci 

adapting themselves to environment 
and elective localization 
and diplococci, chief organisms growing as serophvtic microorgan- 
isms ... 519, 641, 39 
bacterial classification in relation to tissue affected 57 
biological qualities varied in 56 
found in bone 487 
found in dental infections involving root canals and apices and 
supporting structures ....... 67, 71 

•Illustration or chart 

tPlain face figures, Vol. I; ix>kl face, Vol. II. 



116, 



I, 57 

*63 

515 

615 

226 

204 

*205 

95 

55 



265, 125 

318, 54, 55 

54 

64, 265, 266 

124, 126, 127, 279, 282 

. 128 

129 

265, 129 

314 

316 



90, 81, 92, 116, 129, 200, 



90, 314 
113, 133 

95 

. 285 



COMBINED INDEX EOR VOLUMES I AND II 



465 



Streptococci— (continued) 

graphic expressions in types of ... . 

organisms involved in dental tissues understood to be 

present in root fillings with iodoform 

saprophytic ........ 

strike last blow ....... 

Stroke 

and dental infection ...... 



(Pack 

. 57 

55, 627, 25 

60 

519, 343 

406 

. 379 



Structural Changes 
about infected teeth and safety factor . 109, 158, 167, 344, 52 

as basis for classifying characteristics of individuals ... 89 
disclosed in photographs ..... 47 

do not denote quantity or quality of infection .... 573 
due to periodontoclasia . . .153 

local 68, 109, 628, 26 

produced by small quantities of germs ..... 63 

related to systemic susceptibility . *111 

similar in members of a family ...... 80 

surrounding granulomata .... 51 

which develop about infected teeth ..... 580 

which occur in the supporting structures of the teeth . 470 

St. Vitus' Dance 285, 315 

Sublingual 

glands *369, *370, 371, 375 

hypertrophied 373, *374, *376 

Sugar 

in blood 259, 400, 425 

increase in blood 241, 398, 633, 31 

in urine 259, 398, 425 

Sugar Fermentations 

biological properties and expressions in animal tissues not related 58 
determine biological qualities of organisms in root end infection, 
show diplococci ......... 66 

Sulphuric Acid 
efficiency of, for the sterilization of infected teeth . . .186 

Summary 
general 569 to 643, 39 

Supporting Structures— See also Structural Changes 



344, 639, 38 

109, 639, 38 

90, 109, 639, 38 

69 

. 191 

198, 208 

. 129 

470 



changes in, due to dental infection 

chiefly determined by the host 

largely an expression of the capacity for reaction 
different types of reaction involving 
effect on, by implantation of teeth in rabbits 
injured to some extent by use of medicaments . 
necrosis of, in dog, with arsenic .... 
structural changes in, due to infection and irritating processes 

Suppurative 

arthritis *38, *44, *373 

periodontoclasia ...... 158, 344, 134 

Susceptibility 

absent 90, 109, *210 

absent, to putrescent pulps ...... *168 

illustration or chart 

t Plain face figures, Vol. I; bold face, Vol. II. 



466 COMBINED INDEX FOR VOL! MES I AND II 

Si SCEPTIBILITY continued) 

acquired, patients, grouping lesions *86, *93, *lll 

acquired, to putrescent pulps *169 

and contributing factors by modifying defense ol individuals 

and decreased bactericidal content of blood 501. 52( y J 

and inheritance 90. 404 

and resistance, chart "93, 4S 

strong for hearts *102, 104, 318. *91 

chart of deforming arthritis 90, *182, 1 v< 
classification and defensive factors of blcxxl directly related 

501'. *514, *516. 640. 39 
comparison of the three groups of *98, *100, 109, 213 
inheritance of 90, 96. 97, 118 
and arthritis 285. 318. 150 
inherited 90, 246, 261, 283. 284. 286. 317. 329. '360 
chart *93, *247 
inherited, and Mendel's Law . 589 
inherited for insanity 301 
inherited, for stomach involvement 90. 318, *268 
inherited, importance of and diagnosis 90, 109. 53 
inherited, of patients, grouping lesions *88, *93, 105, 107, *111 
inherited, streptococcal 90, 314 
inherited, to chronic carditis 90, 318. 79 
inherited, to putrescent pulps "170. 172 
non, of patients, grouping lesions *84, *93, *111 
of organs . *300 
of patient with rheumatic group lesions related to dental infec- 
tions . *102, 120, 583 
organ and tissue, and difference between elective localization 285 
organ and tissue, and elective localization 285. 318. 633, 32 
quality of, to systemic involvements 582 
record, importance of and use 90, 109, 92. 209 
rheumatic .... 280, 317 
absence of in rarefying osteitis . 109,224 
chart for 31 s 
streptococcal and tubercular, difference in 119 
study showing heart involvements . 90. 78. 1(»4 
tends to develop systemic involvements according to family 

history 108 

to caries, gingival infections, periodontoclasia, symptoms of 

infected teeth . 91 

to deforming arthritis 90, 318, 198 

to dental caries 157, 358 

to kidney involvement . 90, 318. i3ft. 167.168 
to rheumatic group lesions 

during pregnancy and lactation 106 

not increased by periodontoclasia 158, 344, 629, 27 

periodontoclasia related to same *159 

to sensitization, periodontoclasia, skin irritations 396 
to streptococci 55, 90, 81. 02. 116, 12<>. ►200, 316 
to tuberculosis 

and acid-base balance 121 

and decalcification 121 

and odontoclasts reaction 123 

and osteoclastic activity 121, 124 

and type of dental pathology 1 1 (> 

tubercular, and periodontoclasia 11 (> 
•Illustration <>t chart 
►Plain 1 ice figures, Vol. I . lx>l<l face, Vol. 1 1 



COMBINED INDEX FOR VOLUMES I AND II 467 

fPAGE 

Symptoms 

and danger . . 109, 167, 210, 215, 641, 40 

symptoms not a safe guide 167, 210, 641, 40 

type of operation indicated by patient's defense, not by symptoms 

' 210, 642, 40 
as related to caries and systemic involvement . 154, 629, 27 

clinical, and physical conditions as related to the blood 248 

diagnostic, marasmus ... 401, 637, 36 

of an infected tooth 90 

of comfort 

lack of reaction, a danger constituting a paradox . 210, 631, 29 

local, not an index of safety . . 210, 631, 29 

of underweight 210, 401, 92 

patients', and animal reactions .... *288 

Syphilis 

and ovarian and tubal infection *146 

an overload to dental infections . 281 

Systemic Expressions — See also Reactions, Relationships 

as related to local expressions .... 585 

compared with chemical constituents of blood (sensitization) 388 

in dental caries . 154 

. 153 

48, 96 

108, 118 

. 581 



in periodontoclasia 

of dental infections 

related to individual susceptibilities 

the phenomena of, and dental infections . 

Systemic Involvements 

and caries .......... 154 



154, 629, 27 

154, 629, 27 

158, 344 

158, 629, 27 



proportional, as related to symptoms 

proportional, both as cause and effect . 
and periodontoclasia 

reduced susceptibility to rheumatic group lesions 

when appearing is an acquired factor . 158, 344, 629, 27 

and pregnancy . . . 265, 406, 637, 36 

and quantity effect ..... 215, 160 

as compared with blood chemistry and dental pathology . *242 

may be produced by spirochete and ameba infections 409, 638, 36 

Systemic Reactions 

and rheumatic group lesions . 90, 109, 285, 318, 628, 26 

not uniform 285, 318, 628, 26 

related to groups 

Tachycardia . 

Teeth — See Root-filled, Pulpless 

borderline ... 

capacity of, for containing toxic and bacterial products 

crushed, washings from, fatal to rabbits . 

deciduous, delayed exfoliation. 

different, in same individual, compared 

filling in dental operations 

if comfortable, a measure of success of operation? 

infected, a study of the forces operating about root end 

infected, boiled, effects of 

infected deciduous can cause death in children from heart disease 59 

infected from blood stream ... . . 486, *342 

infected, provide substance which combines directly with ionic 
calcium of blood ..... 254, 510 

* Illustration or chart 
tPlain face figures. Vol. I; bold face. Vol. II. 



90, 628 


, 26 


114 : 


358 


10? 


, 81 




367 


215, 22£ 


, 59 




59 


73, 77, 


227 




103 


210, 


214 




574 


457, 464, 


*465 



468 i uMBINKl) INDEX FOR VOLUMES I AND II 

tPAGE 

Teeth -(continued) 

infected, structural changes about and safety factor . 109, 470, 52 

involved by arthritis 486, 128 

justification for extraction of too many (mastication necessar 488 

pulpless, furnishing environment for bacteria 311 

pulpless, whether safe or not 227 

section of, used as a permeable membrane *315 

sockets, after extraction, variation in 351, 474, 608 

service of, and patient's health 210, 52 

testing, for root filling ... 62 

when infected, must be dealt with as foreign substance 315 

Temperature 

streptococcal ..... .113, 133 

subnormal ...... .65 

Testicles 
as dental infections relate to them 425, 428 

inflammation of .... . . *147 

Thalium Sulphate 
used to determine ability of streptococci to adapt themselves to 

environment .... 61 

The Local Phenomena of Dental Focal Infection .... 569 

The Mechanisms of Local and Systemic Defense . . .610 

The Phenomena of Local Reaction ...... 573 

The Phenomena of Relationships between Local and Systemic Ex- 
pressions .......... 585 

The Pnenomena of Sensitization Reactions ..... 596 

The Phenomena of Systemic Expressions of Dental Infections . 581 

The Relation of Gingival and Apical Absorption to Systemic Defense 601 

The Relation of Local Tissue Reaction to Calcium Metabolism 606 

Third Molar 

displacement of ... . *262 

Thymol 
efficiency of, for the sterilization of infected teeth 186 

Thymus .421 

hypertrophy of ........ . *362 

Thyroid 

disturbance of function of, may control factor in metabolism . 587 

involved by lack of iodine in food ...... 422 

involvements subside by removal of dental infections . . 424 

pathological process of, prevented by iodine .... 564 

removed from dogs ......... 432 

Tissues 

affected by types of streptococci .57 

affinity —See Elective Localization 

and organ involvement of (susceptibility) groups *302 

and organ susceptibility and elective localization 285, 318, 633, 32 

and their defense against invading organisms 615 

degeneration of, to what extent do dental infections contribute? 555 
diseased, influence on organisms in distant focus 318 

granulation, comparison of rabbit and patient .... *453 

granulation, nature of ....... 445 

may be affected by spirochete and ameba infections . 409, 638, 36 

'Illustration or chart 

tPlain face figures, Vol. I; bold face. Vol II. 



COMBINED INDEX EOR VOLUMES I AND II 



469 



Tissues— (continued) 
other ........ 

proliferation of, normally and after extraction . 
reaction 

local, as related to calcium metabolism . 

local, found about teeth .... 

related to factor other than type of organism 
structural lesions produced in ... 

Tonsils 
as they relate to endocarditis .... 

Tooth 

absorption . 

-ache and endocarditis . 

a protected environment 

chips, infected, produce nephritis 

function versus heart function 

implantation and pneumonia 

implantation from angina pectoris 

implanted, produces nephritis 

infected and infected sequestrum 

infection and visible absorption 

structure, change in weight to determine capacity of tooth 

toxin and blood calcium 



tPAGE 

. 364 

. 355 

. 606 

110, 458 

71 

64 

55 



121, *42, *388 

133, 134, 55 

311, 95 

. *158 

133. 134, 43 

466, 129, *130 

71, *72 

452, 462, *159 

107 

121, 629, 27 

. *216 

241, 540, 87 

203, 204, *207, *219, *270 

*214, *218 

. *205 

. *205 



Torticollis . 
in rabbit 
muscle infection 
streptococcal infection in 

Toxicity 

in tissues, produced by organisms .... .62 

preventing growth of organisms ...... 60 

Toxic Substance 

formed in pulpless teeth disturbs metabolism in host 233 

from irritant seriously affects blood stream 229, 234, 241, 635, 33 

from pulpless teeth ....... 229 

may produce very profound effects . *230, 401, 632, 30 

tends to prepare tissues of host for infection . 632, 30 

from root-filled teeth may sensitize body or special tissues 364, 632, 30 
from teeth differs from histamine and guanidin . . 562 

from tooth and blood calcium . 241, 540, 87 

in culture medium injurious to organisms. .... 230 

involved in infection process ..... 240 

may sensitize body and tissues and produce reactions . 228 

of bacteria passes through dentino-cemental border . .316 

produces tissue reaction in sensitized tissues .... 382 

Toxins 

and bacterial invasion, injurious effects of . 326 

are neutralized and host maintains defensive mechanism . 65 

are produced by organisms growing in dental infections 67, 569 

from tooth and tooth culture, comparison of . . *327 

from tooth, sensitization reactions to .... *366 

Trapezius 

muscle .......... *205 

Trauma 

as type of irritation ....... 131, 275 

* Illustration or chart 

tPlain face figures, Vol. I; bold face, Vol. II. 



17,) ( OMBINED INDEX FOR VOL1 MES I AND II 

-i- 
1 REATMENT 

and diagnosis, incorrect 282 
Trench Mouth 

shows fusiform and spirochetes 414 
Truth 

new truth a new sense \-j ->j ^44 

Trypsin 

used to predigest organisms 539 
Tubal 

infection * 136 139 

ovarian infection, in relation to syphilis *i4(> 

ulcer 14 - 

Tubercular 

infection probably enters through cavities of dental caries 412 
Tuberculosis 

and blood chemistry 122 

and dental infection 1 1S 

clinical studies of 1 in 

defense for, and calcification 12i 

defense for, and osteoblastic activity 124 

pulmonary, and lung abscess 1 1 * 

susceptibility to 

and acid-base balance 12i 

and decalcification 12i 

and odontoblastic reaction 123 

and osteoclastic activity 121 124 

and periodontoclasia 119 120 

and streptococci, difference in ' 119 

and type of dental pathology 1 1<> 

Ulcer 

of bladder and cystitis >-> 

of eye . ^9 

of stomach 248,249 251, 267 

with perforation 249 

tubal u - 

Understudies 411 

Underweight 280 

as a symptom 40i_ 92 

I'rk Acid 

increase in blood 211 633 M 

I KIM- 

and frees, lack of control of 273 

pH ol 558,586 

pus in v , 

Uterine 

discharge purulenl 285,318,139 IU 

relieved by removal of dental infection 144 
V Ui (NATION 

nl<H>d. in 11(10 510( 526i •«,.» 

•Illustration or chart 
fPlain face figures, Vol. I: bold face, Vol. II. 



COMBINED INDEX FOR VOLUMES I AND II 471 

I'v.i 

Vaccines 

a method for reinforcing deficient defense 526, 640, 39 

autogenous . . 526, 82, 96, 175 

organisms used in ... o37 

used to build up defense . 431, 518, 528, 534, 539, 621 

Vascularization 
changes in, in peridental membrane and cementum of tooth . *147 
destroyed .... . *472 

in sensitization rabbits . . . *375, *376, *377 

Vas Deferens 

and cyst . *140 

Vasomotor 

neurosis .69 

Vertebrae 

diseased *72, *273, *274, *190 

Vitality Tests .... 62 

Vitamins ... 400 

absence of, to produce various types of lesions . 416 

limitation of, in nutrition lowers defense to infection 416, *524, 638, 37 

Walker Index 

expression of phases of blood morphology in . . 237 

Washings — See also Organisms 
comparison of filtered and unfiltered *231, 325 

from crushed teeth, fatal to rabbits 215, 229, 59 

Waxes 

physical properties of ..... . 199, *200 

Weight — See also Dosage 

depression of, as it relates to ionic calcium of blood *257 

loss of, by marasmus .... 401, 637. 36 

of organisms . . .219, 223 

of rabbit and size of dose as they relate to elective localization . *290 
of tooth structure ...... . . 216 

Worry 

as a contributing overload which modifies defensive factors 

265, 633, 31 
Xerophthalmia . . 365, 372, *373, *374, *376 

Xerostomia 365, *369, *370, 371, 372, 375 

prognosis of, bad .... ... 372 

Yellow Fever 95 

Zinc 

compounds used in periodontoclasia ..... 349 

* Illustration or chart 

tPlain face figures. Vol. I; bold face. Vol. II. 



mm 



■ • > 
lttNrctfl 

&llr'*tlEf 'fill 



i 



\m Brett 

















■HHh